Montreal Heart Institute, Montreal, QC, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada.
Transpl Int. 2014 Aug;27(8):824-37. doi: 10.1111/tri.12340. Epub 2014 May 26.
Recent reports suggest that individuals who underwent heart transplantation in the last decade have improved post-transplant kidney function. The objectives of this retrospective study were to describe the incidence and to identify fixed and time-dependent predictors of renal dysfunction in cardiac recipients transplanted over a 25-year period (1983-2008). To illustrate temporal trends, patients (n = 306) were divided into five groups based on year of transplantation. The primary endpoint was the estimated glomerular filtration rate (eGFR) at year 1. Secondary endpoints were time to moderate (eGFR <60 ml/min/1.73 m(2) ) and severe renal dysfunction (eGFR <30 ml/min/1.73 m(2) ). Risk factor analyses relied on multivariable regression models. Kidney function was mildly impaired before transplant (median eGFR=61.0 ml/min/1.73 m(2) ), improved at discharge (eGFR=72.3 ml/min/1.73 m(2) ; P < 0.001), decreased considerably in the first year (eGFR = 54.7 ml/min/1.73 m(2) ; P < 0.001), and deteriorated less rapidly thereafter. At year 1, 2004-2008 recipients exhibited a higher eGFR compared with all other patients (P < 0.001). Factors independently associated with eGFR at year 1 and with moderate and severe renal dysfunction included age, gender, pretransplant eGFR, blood pressure, glycemia, and use of prednisone (P < 0.05). In summary, kidney function worsens constantly up to two decades after cardiac transplantation, with the greatest decline occurring in the first year. Corticosteroid minimization and treatment of modifiable risk factors (hypertension, diabetes) may minimize renal deterioration.
最近的报告表明，在过去十年中接受心脏移植的个体的移植后肾功能有所改善。本回顾性研究的目的是描述在 25 年期间（1983-2008 年）接受心脏移植的患者肾功能障碍的发生率，并确定固定和时间依赖性预测因素。为了说明时间趋势，根据移植年份将患者（n=306）分为五组。主要终点是第 1 年的估算肾小球滤过率（eGFR）。次要终点是肾功能中度（eGFR<60 ml/min/1.73 m(2)）和重度障碍（eGFR<30 ml/min/1.73 m(2)）的时间。风险因素分析依赖于多变量回归模型。移植前肾功能轻度受损（中位 eGFR=61.0 ml/min/1.73 m(2)），出院时改善（eGFR=72.3 ml/min/1.73 m(2)；P<0.001），第 1 年明显下降（eGFR=54.7 ml/min/1.73 m(2)；P<0.001），此后恶化速度较慢。第 1 年，2004-2008 年接受者的 eGFR 高于所有其他患者（P<0.001）。与第 1 年 eGFR 及肾功能中度和重度障碍独立相关的因素包括年龄、性别、移植前 eGFR、血压、血糖和泼尼松的使用（P<0.05）。总之，心脏移植后 20 年内肾功能持续恶化，第 1 年下降幅度最大。皮质类固醇最小化和治疗可改变的危险因素（高血压、糖尿病）可能会最大限度地减少肾功能恶化。
