CCCardiol CroatCardiologia CroaticaCardiol. Croat.1848-543X1848-5448Croatian Cardiac SocietyCC 10_9-10_20810.15836/ccar.2015.208AbstractImpact of reduced creatinine clearance on early heart transplantation outcomes: a propensity score adjusted analysishttp://orcid.org/0000-0002-2492-3702GašparovicHrvoje1http://orcid.org/0000-0003-2740-4067UnicDaniel2http://orcid.org/0000-0002-1242-3575SvetinaLucija1http://orcid.org/0000-0002-9346-6402SamardzicJure1http://orcid.org/0000-0002-4772-5549CikešMaja1http://orcid.org/0000-0002-5420-2324BaricevicZeljko1http://orcid.org/0000-0001-5979-2346SkoricBoško1http://orcid.org/0000-0002-4745-999XKopjarTomislav1http://orcid.org/0000-0002-7378-944XAnicDarko1IvancanVišnja1SutlicZeljko2http://orcid.org/0000-0003-3362-9596BiocinaBojan1http://orcid.org/0000-0001-9101-1570MilicicDavor1University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, CroatiaClinical Hospital Dubrava, Zagreb, CroatiaAddress for correspondence: Hrvoje Gašparovic, Klinicki bolnicki centar Zagreb, Kišpaticeva 12, HR-10000 Zagreb, Croatia. / Phone: +385-1-2367-517 / E-mail: hgasparovic@gmail.com102015109-1020820828082015170920152015Croatian Cardiac SocietyKEYWORDS: heart transplantationrenal failureoutcomes
Goal: Renal insufficiency is a relative contraindication for isolated heart transplantation (HTx). (1-3) We aimed to determine the independent effect of preoperative creatinine clearance (CrCl) on HTx outcomes.
Patients and Methods: 220 patients underwent HTx in Croatia from 2008 to 2014. Four patients were excluded due to missing data. Patients were dichotomized according to a CrCl cut-off value of 50 ml/min (Group A: CrCl≤50 ml/min; Group B: CrCl>50 ml/min). Sixty-three patients (29%) had a CrCl≤50 ml/min. Propensity score (PS) adjustment was performed by accounting for recipient age and gender, AF, smoking, ischemic time, CPB time, BMI, mechanical circulatory assistance (MCS) and reoperation.
Results: Patients in Group A were older (56±11 vs. 49±12 years, P<0.001) and had longer donor ischemic times (197±65 vs. 162±62 min, P<0.001). No significant differences were noted in recipient gender (48/63 (76%) vs. 125/153 (82%) male, P=0.355), donor age (39±13 vs. 39±12 years, P=0.875), donor gender (46/63 (73%) vs. 100/153 (65%) male, P=0.338), PVR (213±107 vs. 188±96 dyn*s*cm−5, P=0.145), diabetes (18/63 (29%) vs. 34/153 (22%), P=0.382), reoperation (18/63 (29%) vs. 34/153 (22%), P=0.382), CPB duration (175±62 vs. 158±56 min, P=0.06) or preoperative MCS (6/63 (10%) vs. 17/153 (11%), P=0.813). Six-month mortality was higher in patients with a CrCl≤50 ml/min (18/63 (29%) vs. 19/153 (12%); unadjusted OR 2.82 [95% CI 1.36-5.84]; P=0.009). Similarly, group A patients were more likely to require renal replacement therapy (RRT) (16/63 (25%) vs. 17/153 (11%); OR 2.72 (1.28-5.82); P=0.012). After PS adjustment these differences remained significant for both 6-month mortality and RRT (OR 2.44 [95% CI 1.09-5.49]; P=0.030 and OR 3.36 [95% CI 1.43-7.92]; P=0.005, respectively).
Conclusions: Patients with a CrCl≤50 ml/min undergoing isolated HTx had inferior 6-month survival and required RRT more commonly. The impact of CrCl remained significant after adjustment for multiple perioperative covariates.
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