Sezgin A, Akay T H, Gültekin B, Ozkan S, Ozdemir N, Aşlamaci S
Baskent University, Faculty of Medicine, Department of Cardiovascular Surgery, Ankara, Turkey.
Transplant Proc. 2007 May;39(4):1247-9. doi: 10.1016/j.transproceed.2007.02.028.
Renal failure after cardiac transplantation is a common and serious complication. In this study we investigated the incidence and effects of renal failure on survival among patients who underwent cardiac transplantation.
Eight patients underwent cardiac and one patient combined cardiac and renal transplantation. The mean age of the patients was 33 +/- 11.6 years (range, 17 to 51). On preoperative echocardiographic evaluation, the mean ejection fraction was calculated as 19 +/- 3.11% (range, 16% to 24%). One patient had compensated renal failure and one patient, dialysis-dependent renal failure. Hemofiltration was routinely used during the operations. Corticosteroids, cyclosporine, and mycophenolate mofetil were used for immunosuppression. Early renal replacement therapy was performed in patients with acute renal failure.
The incidence of acute renal failure was 55.5% (5 patients). In the early postoperative and follow-up periods, the mean ejection fraction was 55 +/- 9.9% and 57 +/- 4.5%, respectively. The mean follow-up period was 21.3 +/- 8.8 (range, 6 to 33) months. In the early initiation period, the mean peak value of cyclosporine blood level was 479 +/- 201.8 ng/mL during the first month, 250 +/- 95.3 and after the third month, 195 +/- 43.7 ng/mL. The mean creatinine level at last follow-up was 1.27 +/- 0.4. One patient experienced a grade III-A rejection episode. One patient died due to coronary artery occlusive disease at 31 months after transplantation.
In our study we have observed that renal failure had no negative effect on patient survival. This can be explained by improved cardiac performance, keeping cyclosporine levels low finding and utilizing early renal replacement treatment.
心脏移植后肾衰竭是一种常见且严重的并发症。在本研究中，我们调查了心脏移植患者中肾衰竭的发生率及其对生存的影响。
8例患者接受了心脏移植，1例患者接受了心脏和肾脏联合移植。患者的平均年龄为33±11.6岁（范围17至51岁）。术前超声心动图评估显示，平均射血分数为19±3.11%（范围16%至24%）。1例患者为代偿性肾衰竭，1例患者为依赖透析的肾衰竭。手术期间常规使用血液滤过。使用皮质类固醇、环孢素和霉酚酸酯进行免疫抑制。急性肾衰竭患者接受早期肾脏替代治疗。
急性肾衰竭的发生率为55.5%（5例患者）。术后早期和随访期间，平均射血分数分别为55±9.9%和57±4.5%。平均随访期为21.3±8.8（范围6至33）个月。在早期起始阶段，第一个月环孢素血药浓度的平均峰值为479±201.8 ng/mL，第三个月后为250±95.3 ng/mL，最后一次随访时平均肌酐水平为1.27±0.4。1例患者发生III - A级排斥反应。1例患者在移植后31个月因冠状动脉闭塞性疾病死亡。
在我们的研究中，我们观察到肾衰竭对患者生存没有负面影响。这可以通过心脏功能改善、保持低环孢素水平以及采用早期肾脏替代治疗来解释。
