Abstract 2366: Elevated Serum Creatinine One Year After Heart Transplantation is a Risk Factor for All-Cause Mortality
Elevated serum creatinine (Cr) in end-stage heart failure, which in large part is due to deteriorated haemodynamics, is a strong risk factor for all-cause mortality. After heart transplantation (HTx), haemodynamics improve but the predictive value of Cr for survival is unclear. We aimed to assess the relationship between Cr at 12 months post-HTx and survival.
METHODS: A total of 386 consecutive HTx recipients attending their first annual visit were studied [mean age 50.8±11.8 SD years; median follow-up 7.3 (range 0.6 –22.3) years]. Data regarding age, gender, smoking, HTx aetiology, hypertension, diabetes, immunosuppressive regime, serum Cr and mortality was collected. Cox regression analysis was used to identify independent risk factors for mortality.
RESULTS: Using 124 μmol/l (local laboratory upper reference limit) as a cut-off, patients were divided into a normal (n=247) and elevated (n=139) Cr group. There were 64 (26%) and 62 (45%) deaths in the normal and elevated Cr group, respectively (p<0.001-see figure⇓). Only a small number of these deaths were directly attributable to renal failure (6 and 9 deaths in the normal and elevated Cr groups, respectively). Univariate analysis found age, hypertension, atherosclerosis as aetiology for HTx and elevated Cr to be associated with decreased survival. Multivariate Cox analysis identified elevated Cr (HR 2.13, p=0.001) and atherosclerosis as aetiology for HTx (HR 1.65, p=0.007) as independent risk factors for mortality.
CONCLUSION: Elevated Cr at 12 months post-HTx is an independent risk factor for all-cause mortality. Cr is routinely measured in HTx patients and elevated levels may warrant a more intensive follow-up regime.