BACKGROUND: Renal failure has been a consistent risk factor for mortality after heart transplantation. From the ISHLT Registry approximately one third of patients have an abnormal creatinine after heart transplantation. There has been concern that development of even mild renal insufficiency in the first year after transplant may portend poor outcome. We reviewed our experience in patients with mild renal insufficiency at 1 year after heart transplantation for long-term outcome.

METHODS: Between 1994-2010, we evaluated 384 heart transplant patients with serum creatinine<1.6mg/dl at one year post transplant. All patients were assessed for subsequent 5-year survival, freedom from cardiac allograft vasculopathy and nonfatal major adverse cardiac events (NF-MACE, defined as myocardial infarction, heart failure, need for percutaneous cardiac intervention, stroke). Multivariate analysis was used to assess the independent risk for death with creatinine (as a continuous variable) as well as recipient age, donor age, gender, desensitization pre-transplantation, diabetes in the first year, induction therapy.

RESULTS: Patients with mild renal insufficiency (creatinine 1.2-1.5mg/dl) at one year after transplant had significantly lower survival compared to patients with normal creatinine (84% vs 91%, p=0.026). There was no difference in 1-year rejection or 5-year freedom from CAV or NF-MAC E between groups. Upon multivariate analysis, creatinine (up to 1.5mg/dl)was an independent risk factor for 5-year mortality (HR 4.3, p=0.027).

CONCLUSION: Mild renal insufficiency up to serum creatinine of 1.5mg/dl at one year post heart transplant appears to be a risk factor for 5-year mortality. Avoiding any renal impairment in first year after transplant appears to be paramount.

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