Severity of Hypertension After Heart Transplant: Does It Impact Outcome?

Abstract

Purpose: Acute kidney injury (AKI) is a frequent complication of cardiac transplantation and associated with adverse outcomes within the first postoperative year. This study describes the association between AKI and long-term adverse outcome after cardiac transplantation. Methods: The study population included 471 adult recipients that survived the first postoperative year. AKI was defined by the Kidney Disease Improving Global Outcome (KDIGO) criteria. Primary outcome variables were overall and renal survival defined as time to start of chronic renal replacement therapy (RRT). The secondary outcome variable was renal function 10 years after transplantation. Results: Overall survival rates were 90%, 64%, 29%, 20% and 11% and renal survival rates were 97%, 84%, 76%, 69% and 69%, at 5,10,15,20 and 25 years, respectively. No crude association was found between AKI staged by KDIGO criteria and mortality (P= 0.50) or chronic RRT dependence (P= 0.47). Additionally, no crude association was found for AKI requiring RRT and mortality (P= 0.27). A significant association was found between AKI requiring RRT and a higher risk for chronic RRT dependence (P= 0.02). In multivariable analysis AKI requiring RRT was associated with an increased risk for mortality (HR= 2.75, P= 0.03) and chronic RRT dependency (HR= 13.14, P< 0.001). In addition, also an estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73m2 at one year after transplantation was associated with mortality (HR= 2.69, P< 0.001) and an eGFR 30-59 (HR= 3.57, P= 0.007) and an eGFR < 30 (HR= 16.53, P< 0.001) with chronic RRT dependence, respectively. Furthermore, independent association was found between AKI requiring RRT and renal function 10 years thereafter (β =-29.72, P= 0.02). Conclusion: Besides AKI requiring RRT, less severe episodes of AKI have limited implications for the cardiac transplantation recipient's long-term prognosis. However, impaired renal function one year after transplantation is an important predictor for long-term mortality and chronic RRT dependence.

Immunosuppressive Medication and Non-Rejection-Related Complications Following Heart Transplantation

“…8,9 Data from the international literature also show that hypertension after transplantation is common, with an incidence of 70-90% in patients treated with cyclosporine and 30-50% in those treated with tacrolimus. 10,11 Both tacrolimus and cyclosporine may influence blood pressure levels and favor hyperlipidemia, as shown by Han et al 12 Regarding renal dysfunction, it has been demonstrated that immunosuppressive therapy with cyclosporine has improved graft function and survival time in transplant patients. However, cyclosporine-induced nephrotoxicity remains a medical challenge for post-heart transplant management.…”