Trends in post-operative mortality in patients requiring renal replacement therapy following cardiothoracic transplantation

Renal failure requiring renal replacement therapy (RRT) increases mortality after any operation. Cardiothoracic surgery carries a high risk of post-operative renal failure, but the effect of the management of RRT on mortality is unclear in these patients. The aim of this study was to determine the changes in mortality over a 15-year period in patients requiring RRT following cardiothoracic transplantation. We performed a retrospective review of all 406 patients who received a heart (n = 359) or lung (n = 49) transplant in a single tertiary care centre from November 1986 to October 1999. Two patients underwent a second heart transplantation and one patient received a combined heart/renal transplant during this period.

The requirement for RRT has not significantly altered over the time period of the study. However there has been a dramatic reduction in the 30-day mortality in patients treated with RRT which is sustained through to the end of the first year. This is likely to be due to earlier implementation of RRT with its associated improvements in nutrition and homeostasis.

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