Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study
Acute kidney injury and renal failure are common after heart transplantation. We retrospectively reviewed a national cohort and identified 1129 heart transplant patients. Patients receiving renal replacement therapy after heart transplantation were grouped into the dialysis cohort. The long-term sur...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2020-07-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/9/8/2455 |
| _version_ | 1797560681267986432 |
|---|---|
| author | Tsai-Jung Wang Ching-Heng Lin Hao-Ji Wei Ming-Ju Wu |
| author_facet | Tsai-Jung Wang Ching-Heng Lin Hao-Ji Wei Ming-Ju Wu |
| author_sort | Tsai-Jung Wang |
| collection | DOAJ |
| description | Acute kidney injury and renal failure are common after heart transplantation. We retrospectively reviewed a national cohort and identified 1129 heart transplant patients. Patients receiving renal replacement therapy after heart transplantation were grouped into the dialysis cohort. The long-term survival and risk factors of dialysis were investigated. Patients who had undergone dialysis were stratified to early or late dialysis for subgroup analysis. The mean follow-up was five years, the incidence of dialysis was 28.4% (21% early dialysis and 7.4% late dialysis). The dialysis cohort had higher overall mortality compared with the non-dialysis cohort. The hazard ratios of mortality in patients with dialysis were 3.44 (95% confidence interval (CI), 2.73–4.33) for all dialysis patients, 3.58 (95% CI, 2.74–4.67) for early dialysis patients, and 3.27 (95% CI, 2.44–4.36; all <i>p</i> < 0.001) for late dialysis patients. Patients with diabetes mellitus, chronic kidney disease, acute kidney injury, and coronary artery disease were at higher risk of renal failure requiring dialysis. Cardiomyopathy, hepatitis B virus infection, and hyperlipidemia treated with statins were associated with a lower risk of renal dysfunction requiring early dialysis. The use of Sirolimus and Mycophenolate mofetil was associated with a lower incidence of late dialysis. Renal dysfunction requiring dialysis after heart transplantation is common in Taiwan. Early and late dialysis were both associated with an increased risk of mortality in heart transplant recipients. |
| first_indexed | 2024-03-10T18:04:06Z |
| format | Article |
| id | doaj.art-54b8e2415f814f308a712797b3e1ca9a |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T18:04:06Z |
| publishDate | 2020-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-54b8e2415f814f308a712797b3e1ca9a2023-11-20T08:39:30ZengMDPI AGJournal of Clinical Medicine2077-03832020-07-0198245510.3390/jcm9082455Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort StudyTsai-Jung Wang0Ching-Heng Lin1Hao-Ji Wei2Ming-Ju Wu3School of Public Health, The University of Texas Health Science Center (UTHealth), Houston, TX 77030, USADepartment of Medical Research, Taichung Veterans General Hospital, Taichung 407, TaiwanDepartment of Cardiovascular Surgery, Cardiovascular Center, Taichung Veterans General Hospital, Taichung 407, TaiwanDivision of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, TaiwanAcute kidney injury and renal failure are common after heart transplantation. We retrospectively reviewed a national cohort and identified 1129 heart transplant patients. Patients receiving renal replacement therapy after heart transplantation were grouped into the dialysis cohort. The long-term survival and risk factors of dialysis were investigated. Patients who had undergone dialysis were stratified to early or late dialysis for subgroup analysis. The mean follow-up was five years, the incidence of dialysis was 28.4% (21% early dialysis and 7.4% late dialysis). The dialysis cohort had higher overall mortality compared with the non-dialysis cohort. The hazard ratios of mortality in patients with dialysis were 3.44 (95% confidence interval (CI), 2.73–4.33) for all dialysis patients, 3.58 (95% CI, 2.74–4.67) for early dialysis patients, and 3.27 (95% CI, 2.44–4.36; all <i>p</i> < 0.001) for late dialysis patients. Patients with diabetes mellitus, chronic kidney disease, acute kidney injury, and coronary artery disease were at higher risk of renal failure requiring dialysis. Cardiomyopathy, hepatitis B virus infection, and hyperlipidemia treated with statins were associated with a lower risk of renal dysfunction requiring early dialysis. The use of Sirolimus and Mycophenolate mofetil was associated with a lower incidence of late dialysis. Renal dysfunction requiring dialysis after heart transplantation is common in Taiwan. Early and late dialysis were both associated with an increased risk of mortality in heart transplant recipients.https://www.mdpi.com/2077-0383/9/8/2455acute kidney injury (AKI)chronic kidney disease (CKD)dialysisheart transplantation (HT)immunosuppressantmortality |
| spellingShingle | Tsai-Jung Wang Ching-Heng Lin Hao-Ji Wei Ming-Ju Wu Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study Journal of Clinical Medicine acute kidney injury (AKI) chronic kidney disease (CKD) dialysis heart transplantation (HT) immunosuppressant mortality |
| title | Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study |
| title_full | Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study |
| title_fullStr | Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study |
| title_full_unstemmed | Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study |
| title_short | Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study |
| title_sort | long term outcomes and risk factors of renal failure requiring dialysis after heart transplantation a nationwide cohort study |
| topic | acute kidney injury (AKI) chronic kidney disease (CKD) dialysis heart transplantation (HT) immunosuppressant mortality |
| url | https://www.mdpi.com/2077-0383/9/8/2455 |
| work_keys_str_mv | AT tsaijungwang longtermoutcomesandriskfactorsofrenalfailurerequiringdialysisafterhearttransplantationanationwidecohortstudy AT chinghenglin longtermoutcomesandriskfactorsofrenalfailurerequiringdialysisafterhearttransplantationanationwidecohortstudy AT haojiwei longtermoutcomesandriskfactorsofrenalfailurerequiringdialysisafterhearttransplantationanationwidecohortstudy AT mingjuwu longtermoutcomesandriskfactorsofrenalfailurerequiringdialysisafterhearttransplantationanationwidecohortstudy |