https://scholars.lib.ntu.edu.tw/handle/123456789/605772
標題: | Impact of Pretransplant Renal Replacement Therapy on Clinical Outcome After Isolated Heart Transplantation | 作者: | JENG-WEI CHEN NAI-KUAN CHOU CHIH-HSIEN WANG NAI-HSIN CHI SHU-CHIEN HUANG HSI-YU YU YIH-SHARNG CHEN RON-BIN HSU |
關鍵字: | acute kidney injury; heart transplant; long term survival; renal failure; renal replacement therapy | 公開日期: | 2022 | 卷: | 35 | 來源出版物: | Transplant international : official journal of the European Society for Organ Transplantation | 摘要: | End stage renal disease (ESRD) is a contraindication to isolated heart transplantation (HT). However, heart candidates with cardiogenic shock may experience acute kidney injury and require renal replacement therapy (RRT) and isolated HT as a life-saving operation. The outcomes, including survival and renal function, are rarely reported. We enrolled 569 patients undergoing isolated HT from 1989 to 2018. Among them, 66 patients required RRT before HT (34 transient and 32 persistent). The survival was worse in patients with RRT than those without (65.2% vs 84.7%; 27.3% vs 51.1% at 1- and 10-year, p < 0.001 and p = 0.012, respectively). Multivariate Cox analysis identified pre-transplant hyperbilirubinemia (Hazard ratio (HR) 2.534, 95% confidence interval (CI) 1.098-5.853, p = 0.029), post-transplant RRT (HR 5.551, 95%CI 1.280-24.068, p = 0.022) and post-transplant early bloodstream infection (HR 3.014, 95%CI 1.270-7.152, p = 0.012) as independent risk factors of 1-year mortality. The majority of operative survivors (98%) displayed renal recovery after HT. Although patients with persistent or transient RRT before HT had a similar long-term survival, patients with persistent RRT developed a high incidence (49.2%) of dialysis-dependent ESRD at 10 years. In transplant candidates with pretransplant RRT, hyperbilirubinemia should be carefully re-evaluated for the eligibility of HT whereas prevention and management of bloodstream infection after HT improve survival. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/605772 | ISSN: | 09340874 | DOI: | 10.3389/ti.2022.10185 |
顯示於: | 醫學系 |
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