Authors

• Hrvoje Gašparovic — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-2492-3702
• Daniel Unic — Clinical Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0003-2740-4067
• Lucija Svetina — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-1242-3575
• Jure Samardzic — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-9346-6402
• Maja Cikeš — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-4772-5549
• Zeljko Baricevic — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-5420-2324
• Boško Skoric — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-5979-2346
• Tomislav Kopjar — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-4745-999X
• Darko Anic — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-7378-944X
• Višnja Ivancan — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
• Zeljko Sutlic — Clinical Hospital Dubrava, Zagreb, Croatia
• Bojan Biocina — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-3362-9596
• Davor Milicic — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-9101-1570

Abstract

Goal: Renal insufficiency is a relative contraindication for isolated heart transplantation (HTx). (1-3) We aimed to determine the independent effect of preoperative creatinine clearance (CrCl) on HTx outcomes. Patients and Methods: 220 patients underwent HTx in Croatia from 2008 to 2014. Four patients were excluded due to missing data. Patients were dichotomized according to a CrCl cut-off value of 50 ml/min (Group A: CrCl≤50 ml/min; Group B: CrCl>50 ml/min). Sixty-three patients (29%) had a CrCl≤50 ml/min. Propensity score (PS) adjustment was performed by accounting for recipient age and gender, AF, smoking, ischemic time, CPB time, BMI, mechanical circulatory assistance (MCS) and reoperation. Results: Patients in Group A were older (56±11 vs. 49±12 years, P<0.001) and had longer donor ischemic times (197±65 vs. 162±62 min, P<0.001). No significant differences were noted in recipient gender (48/63 (76%) vs. 125/153 (82%) male, P=0.355), donor age (39±13 vs. 39±12 years, P=0.875), donor gender (46/63 (73%) vs. 100/153 (65%) male, P=0.338), PVR (213±107 vs. 188±96 dyn*s*cm−5, P=0.145), diabetes (18/63 (29%) vs. 34/153 (22%), P=0.382), reoperation (18/63 (29%) vs. 34/153 (22%), P=0.382), CPB duration (175±62 vs. 158±56 min, P=0.06) or preoperative MCS (6/63 (10%) vs. 17/153 (11%), P=0.813). Six-month mortality was higher in patients with a CrCl≤50 ml/min (18/63 (29%) vs. 19/153 (12%); unadjusted OR 2.82 [95% CI 1.36-5.84]; P=0.009). Similarly, group A patients were more likely to require renal replacement therapy (RRT) (16/63 (25%) vs. 17/153 (11%); OR 2.72 (1.28-5.82); P=0.012). After PS adjustment these differences remained significant for both 6-month mortality and RRT (OR 2.44 [95% CI 1.09-5.49]; P=0.030 and OR 3.36 [95% CI 1.43-7.92]; P=0.005, respectively). Conclusions: Patients with a CrCl≤50 ml/min undergoing isolated HTx had inferior 6-month survival and required RRT more commonly. The impact of CrCl remained significant after adjustment for multiple perioperative covariates.

Keywords

heart transplantation, renal failure, outcomes

DOI

Literature

1. Ojo AO, Held PJ, Port FK, Wolfe RA, Leichtman AB, Young EW, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med. 2003;349:931–40. https://doi.org/10.1056/NEJMoa021744
2. Haglund NA, Feurer ID, Dwyer JP, Stulak JM, DiSalvo TG, Keebler ME, et al. Does renal dysfunction and method of bridging support influence heart transplant graft survival? Ann Thorac Surg. 2014;98:835–41. https://doi.org/10.1016/j.athoracsur.2014.05.059
3. Gašparović H, Milicic D, Biocina B. Contemporary challenges in the management of advanced heart failure. Croat Med J. 2014;55:551–2. https://doi.org/10.3325/cmj.2014.55.551