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J Thorac Cardiovasc Surg 2010;140:688-693
© 2010 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Serum cystatin C is an easy to obtain biomarker for the onset of renal impairment in heart transplant recipients

^a Division of Transplantation, Department of Surgery, Medical University Graz, Graz, Austria
^b Department of Internal Medicine, Medical University Graz, Graz, Austria

Received for publication December 5, 2009; revisions received February 14, 2010; accepted for publication March 20, 2010.

^_* Address for reprints: Daniela Kniepeiss, MD, Department of Surgery, Division of Transplantation, Medical University, Auenbruggerplatz 29, 8036 Graz, Austria. (Email: daniela.kniepeiss{at}medunigraz.at).

Objective: With the increasing longevity of heart transplant recipients, the long-term effects of cyclosporine on renal function have become more evident. Highly sensitive, early, and effective monitoring of posttransplant renal function is still being researched. This study aimed to evaluate the prognostic value of cystatin C for patients after heart transplantation.

Methods: Seventy-three long-term recipients of a heart transplant more than 5 years before the study start were included in the analysis with a follow-up of 4 years. Serum creatinine, renal glomerular filtration rate calculated by the Modification of Diet in Renal Disease formula, and serum cystatin C levels were collected, and risk factors for renal dysfunction were assessed. Statistical analysis was performed for all patients.

Results: Univariate analysis showed a prognostic impact of antihypertensive medication and onset of diabetes (P < .001) on renal failure after transplantation. Multivariate analysis yielded cystatin C measured at the study start as a superior prognostic parameter for all time points (area under the receiver operating characteristic 12 months: 0.963; 24 months: 0.910; 48 months: 0.949) compared with the conventionally used creatinine levels.

Conclusions: Our results showed an enormous potential of serum cystatin C as an early prognostic and easy to obtain biomarker for renal dysfunction after heart transplantation.

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