Renal function at 1?year after cardiac transplantation rather than acute kidney injury is highly associated with long‐term patient survival and loss of renal function – a retrospective cohort study

摘要

Summary This study aimed to assess the association between acute kidney injury ( AKI ), renal function 1?year after transplantation, and long‐term adverse outcomes after cardiac transplantation. A retrospective cohort study was performed including 471 adult cardiac transplantation recipients that survived the first postoperative year between 1984 and 2012. Primary outcome variables were long‐term overall and renal survival. During the first postoperative week, 40% ( n ?=?188) of the recipients developed AKI stage I, 22% ( n ?=?104) stage II , and 13% ( n ?=?63) stage III , and 4% ( n ?=?17) required temporary renal replacement therapy ( RRT ). No crude association was found between the development of AKI and long‐term mortality ( P ?=?0.50) or chronic RRT dependence ( P ?=?0.27). In multivariable analysis, only AKI requiring RRT was associated with an increased risk for mortality ( HR ?=?2.59, 95% CI ?=?1.17–5.73) and chronic RRT dependence ( HR ?= 13.14, 95% CI ?=?3.26–52.92). While less severe episodes of AKI did not affect the recipient's long‐term prognosis, renal function 1?year after transplantation had a strong association with long‐term outcome. An eGFR 30?ml/min/1.73 was independently associated with mortality ( HR ?=?2.69, 95% CI ?=?1.68–4.32) and an eGFR 60?ml/min/1.73 with chronic RRT dependence ( eGFR 30–59: HR ?=?3.57, 95% CI ?=?1.41–9.01; eGFR 30: HR ?=?16.53, 95% CI ?=?5.72–47.78). In conslusion, besides AKI requiring RRT , less severe episodes of AKI have limited implications for the recipient's prognosis and long‐term outcome after cardiac transplantation is strongly determined by the degree of renal impairment 1?year after transplantation.