Ptak Jakub, Sokolski Mateusz, Wilk Mateusz, Waloszczyk Mateusz, Wiśniewski Kacper, Krupka Dominik, Makowska Paulina, Cielecka Magdalena, Szwajkowski Maciej, Rakowski Mateusz, Bochenek Maciej, Przybylski Roman, Zakliczyński Michał
Institute of Heart Diseases, Jan Mikulicz Radecki University Hospital Wroclaw, 50556 Wroclaw, Poland.
Clinical Department of Heart Transplantation and Mechanical Circulatory Support, Department of Cardiac, Surgery and Heart Transplantation, Institute of Heart Diseases, Faculty of Medicine, Wroclaw Medical University, 50368 Wroclaw, Poland.
Biomedicines. 2025 Apr 10;13(4):933. doi: 10.3390/biomedicines13040933.
: Patients with advanced heart failure (HF) often suffer from impaired kidney function. Based on the pathophysiology of types I and II of cardiorenal syndrome, heart transplantation (Htx) may restore renal function. The aim of this study was to identify predictors of improvement in kidney function after HTx. : Htx patients from a tertiary hospital were retrospectively divided into three groups-improvement (n = 24), deterioration (n = 31) and no significant change in eGFR (n = 45)-based on changes in their mean estimated glomerular filtration rate (eGFR) within the first three postoperative months, compared to the last three preoperative months. The threshold for eGFR improvement was defined as a ≥20% increase, while deterioration was defined as a ≥20% decrease. The no significant change group was defined as any change falling between these two values. : The median age of analyzed cohort was 54 (45-63) years, and 82% were male. Preoperatively, the improvement group was more frequently treated with inotropes or vasopressors and had significantly higher blood urea and total bilirubin levels before Htx. In the multivariate analysis, total bilirubin before Htx (OR 1.66; 95% CI; 1.24-2.69; = 0.002) and no need for RRT early after Htx (OR 0.46; 95% CI 0.24-0.88; = 0.02) were independent predictors of improved kidney function in the first three months after HTx. : The improvement in renal function after HTx is uncommon. It could be expected in patients suffering from more severe forms of HF, with impaired kidney and liver function but who did not need RRT after the surgery.
晚期心力衰竭（HF）患者常伴有肾功能受损。基于心肾综合征I型和II型的病理生理学，心脏移植（Htx）可能恢复肾功能。本研究的目的是确定心脏移植后肾功能改善的预测因素。：对一家三级医院的心脏移植患者进行回顾性分组，根据术后前三个月与术前最后三个月相比平均估计肾小球滤过率（eGFR）的变化，分为改善组（n = 24）、恶化组（n = 31）和eGFR无显著变化组（n = 45）。eGFR改善的阈值定义为增加≥20%，而恶化定义为降低≥20%。无显著变化组定义为介于这两个值之间的任何变化。：分析队列的中位年龄为54（45 - 63）岁，82%为男性。术前，改善组更频繁地使用正性肌力药物或血管升压药，且心脏移植前血尿素和总胆红素水平显著更高。在多变量分析中，心脏移植前的总胆红素（OR 1.66；95% CI；1.24 - 2.69；P = 0.002）和心脏移植后早期无需肾脏替代治疗（RRT）（OR 0.46；95% CI 0.24 - 0.88；P = 0.02）是心脏移植后前三个月肾功能改善的独立预测因素。：心脏移植后肾功能改善并不常见。在患有更严重形式心力衰竭、伴有肾和肝功能受损但术后无需肾脏替代治疗的患者中可能会出现这种情况。
