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논문분류	춘계학술대회 초록집
제목	Predictors of renal outcome after heart transplantation – a nationwide retrospective study
저자	Junseok Jeon, Hyo Jin Boo, Hyejeong Park, Danbee Kang, Juhee Cho, Jung Eun Lee, Wooseong Huh, Yoon-Goo Kim, Dae Joong Kim, Hye Ryoun Jang
출판정보	2020; 2020(1):
키워드	heart transplantation \| chronic kidney disease \| end stage kidney disease \| renal outcome \| national health insurance
초록	Renal dysfunction after heart transplantation (HT) is associated with poor outcome. Although simultaneous heart and kidney transplantation (HKT) has been recommended in patients with irreversible severe renal dysfunction, consensus regarding the indication for simultaneous HKT is lacking. Predicting renal outcome after HT is a substantial but difficult issue considering organ shortage. We investigated the predictive factors of renal outcome after HT using a nationwide cohort data. We conducted a retrospective cohort study using the Korean ICU National Data (KIND) registry of Health Insurance Review and Assessment database. A total of 654 patients who received HT between January 2007 and September 2016 and survived to hospital discharge were included in the final analyses. The median (interquartile range) age was 52 (40-60) years and 68.1% were male. Perioperative renal replacement therapy (RRT) was performed in 27.8% of the patients. During a median of 2.8 years of follow-up, end-stage kidney disease (ESKD) developed in 12 of 654 patients (1.8%). In a fully-adjusted model, preexisting renal disease (HR 3.85; 95% CI, 1.24-11.98), RRT > 21 days (HR 8.74; 95% CI, 3.49-21.94), and inotropics/vasopressors (HR 7.85; 95% CI, 2.81-21.89) were associated with ESKD. Among 561 patients without chronic kidney disease (CKD), CKD developed in 104 patients (20.0%). Age (HR 1.03; 95% CI, 1.01-1.05), extracorporeal membrane oxygenation (ECMO) (HR 1.54; 95% CI, 1.14-2.07), and RRT (HR, 3.71; 95% CI, 1.50-9.15) were associated with the development of CKD. Our nationwide cohort study demonstrated that preexisting renal disease and perioperative RRT were predictors of poor renal outcome after HT. These results suggest that HT should be performed before irreversible renal damage occurs and that active renoprotective strategy may be required during the perioperative period.
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