• Ivan Knezevic, Gregor Poglajen, Eva Hrovat, Anja Oman, Tatjana Pintar, Joseph C Wu, Bojan Vrtovec, and François Haddad.
• Advanced Heart Failure and Transplantation Center, UMC, Ljubljana, Slovenia.
• Clin Transplant. 2014 Oct 1;28(10):1105-11.

BackgroundWe evaluated the effects of a levosimendan (LS)-based strategy compared with standard inotropic therapy on renal function in heart transplantation.Methods And ResultsUsing a randomized study design, 94 patients were assigned to LS-based therapy or standard inotropic support. At the time of transplantation, the groups did not differ in age, gender, heart failure etiology, hemodynamic profile, LVEF, or comorbidities. While there were no differences in serum creatinine (sCr) or eGFR between groups at baseline, patients in the LS group had a greater increase in their relative eGFR (62% vs. 12%, p = 0.002) and a lower incidence of acute kidney injury (AKI) (28% vs. 6%, p = 0.01) during the first post-transplant week. On logistic regression analysis, correlates of AKI were randomization to LS therapy (OR = 0.21 [0.09-0.62], p = 0.01), baseline renal dysfunction (OR = 3.9 [1.1-13.6], p = 0.032), and diabetes mellitus (OR = 4.2 [1.1-16.5], p = 0.038). However, LS was associated with a greater need for additional norepinephrine therapy (40 [85%] vs. 15 [31%], p < 0.001) and a trend toward longer intensive care unit stay (9.5 ± 9.0 d vs. 7.0 ± 6.0 d, p = 0.13).ConclusionsIn patients undergoing heart transplantation, levosimendan-based strategy may be associated with better renal function when compared to standard therapy.© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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