Analysis of Risk Factors for Kidney Dysfunction After Heart Transplantation and Its Effect on Prognosis

Background: To comprehensively analyze the incidence and long-term outcomes of postoperative renal dysfunction (RD) and explore the clinical predictors associated with postoperative RD. Methods: A retrospective review of relevant clinical data was conducted for 1 095 heart transplant recipients. The recipients were categorizedinto two groups: RD (352 cases) and non-RD (normal, 743 cases), based on whether RD occurred after HT. Results: The median follow-up period was 5.6 years. Among the 352 RD patients (32.1%), RD cases included new-onset RD (276 cases, 25.2%), RD occurring during postoperative hospitalization (99, 28.1%), and RD occurring post-discharge until the first year (111 cases, 31.5%). The RD group exhibited characteristics such as advanced age, higher BMI, elevated preoperative serum creatinine levels, prolonged cardiopulmonary bypass time, a higher proportion of males, and a higher ratio of comorbidities (diabetes, preoperative RD, previous graft failure,ECMO support, and intra-aortic balloon pump (IABP) support). Donors in RD group were also characterized by advanced age and a higher proportion of males (all P<0.05). Postoperatively, the RD group had higher rates of ECMO/IABP implantation, tracheostomy, infection, longer postoperative mechanical ventilation times, longer stays in the intensive care unit (ICU) stay, and longer in-hospital stay than normal group (P<0.05). The long-term survival of patients with postoperative RD was significantly lower than that of patients with normal kidney function (P<0.01). The long-term survival rate of patients with preoperative RD was significantly lower than that of patients without preoperative RD, regardless of whether kidney function normalized postoperatively. Additionally, the long-term survival rate of patients with postoperative new-onset RD was significantly lower than that of those with normal kidney function (P<0.01). Independent risk factors for RD post-HT include advanced recipient age, higher BMI, preoperative RD, postoperative cyclosporine dosing (versus tacrolimus) and ischemic time ≥ 6 h. Conclusion: RD primarily occurswithin the first year post-HT. Advanced recipient age, higher BMI, preoperative RD, and ischemic time ≥ 6 h are identified as independent predictors of RD post-HT. The incidence of RD after HT significantly impacts both perioperative and long-term survival rates.