Lubitz Steven A, Pinney Sean, Wisnivesky Juan P, Gass Alan, Baran David A
Zena and Michael Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, New York, USA.
J Heart Lung Transplant. 2007 Mar;26(3):264-72. doi: 10.1016/j.healun.2006.12.003.
Chronic renal failure (CRF) after heart transplantation is common, although risk factors for its development and potential preventive interventions are not well established.
In this study we retrospectively assessed the cumulative incidence of CRF and identified independent predictors of CRF in heart transplant recipients between August 1986 and January 2003.
Among the 218 patients included in the analysis, the cumulative incidence of CRF was 4.5% at 5 years, and 19.6% at 10 years after transplant. Multivariate Cox modeling revealed that diabetes mellitus prior to transplant was associated with an increased risk of CRF (hazards ratio [HR] 7.11, p < 0.01), whereas factors associated with a reduced risk of CRF included a pre-transplant creatinine clearance > or = 60 ml/min/1.73 m2 (HR 0.30, p = 0.01) and treatment with a statin after transplant (HR 0.25, p < 0.01). Patients who developed CRF after transplant were at higher risk of death (HR 8.5, p < 0.01).
CRF is common after cardiac transplantation and is associated with substantial mortality. The reduced risk of CRF observed with statin therapy warrants prospective study, with particular emphasis on the mechanisms of progression to CRF in this population.
心脏移植后慢性肾衰竭（CRF）很常见，但其发生的危险因素和潜在的预防干预措施尚未完全明确。
在本研究中，我们回顾性评估了1986年8月至2003年1月间心脏移植受者CRF的累积发病率，并确定了CRF的独立预测因素。
纳入分析的218例患者中，移植后5年CRF的累积发病率为4.5%，10年为19.6%。多变量Cox模型显示，移植前糖尿病与CRF风险增加相关（风险比[HR] 7.11，p < 0.01），而与CRF风险降低相关的因素包括移植前肌酐清除率≥60 ml/min/1.73 m2（HR 0.30，p = 0.01）和移植后使用他汀类药物治疗（HR 0.25，p < 0.01）。移植后发生CRF的患者死亡风险更高（HR 8.5，p < 0.01）。
心脏移植后CRF很常见，且与高死亡率相关。他汀类药物治疗观察到的CRF风险降低值得进行前瞻性研究，尤其应关注该人群中CRF进展的机制。
