目的:分析心脏移植术前合并肾功能不全受者的心脏移植临床预后和术后肾功能变化趋势，并总结相关处理经验。方法:回顾性分析2015年1月至2018年12月在华中科技大学同济医学院附属协和医院接受原位心脏移植受者(≥18岁)的临床资料，并采用CKD-EPI公式计算受者术前的估算肾小球滤过率(eGFR)。根据2012年改善全球肾脏疾病预后组织发布的eGFR分类标准，将受者分为四组：M1组(术前eGFR≥90 ml/min/1.73 mn 2)，M2组(术前eGFR为60～89 ml/min/1.73 mn 2)，M3组(术前eGFR为45～59 ml/min/1.73 mn 2)，M4组(术前eGFR<45 ml/min/1.73 mn 2)。比较各组受者术后1年的临床预后。主要终点分析术前eGFR是否是受者全因死亡的独立预测因子，次要终点包括术后连续肾脏替代治疗(CRRT)使用率、住院周期和肾功能的变化趋势等。n 结果:共纳入276例受者，其中eGFR<60 ml/min/1.73 mn 2的受者占24.6%。与eGFR≥90 ml/min/1.73 mn 2相比，调整模型后的1年内死亡率风险比分别为1.78(M3组，95%CI为1.31～3.39)和2.74(M4组，95%CI为1.41～5.32)，且M4组受者的死亡率风险比、CRRT使用率及住院周期风险也明显增加；移植前eGFR中位数为73 ml/min/1.73 mn 2，术后3个月后降至61 ml/min/1.73 mn 2，此后逐渐趋于稳定，各组eGFR的改变趋势基本相似。n 结论:心脏移植术前的eGFR是受者术后短期存活率的独立预测因子；移植术后3个月eGFR可能逐渐恶化，经过恰当处理，术后3个月后eGFR甚至好转。“,”Objective:To explore the relationship between preoperative estimated glomerular filtration rate (eGFR) and short-term survival rate of orthotopic heart transplantation and postoperative renal prognosis.Methods:From January 2015 to December 2018, clinical data were retrospectively analyzed for orthotopic heart transplantation recipients (≥18 years) and the formula of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) was utilized for estimating the receptor preoperative glomerular filtration rate (eGFR). Recipients were divided into four categories (M1: eGFR≥90, M2: 60-89, M3: 45-59 & M4<45) according to the GFR classification scheme of global Renal Disease Prognosis Organization in 2012. Clinical prognoses were compared. The primary endpoint was to assess whether PRE-OHT eGFR was an independent predictor of all-cause mortality. Secondary endpoints included continuous renal replacement therapy(CRRT), duration of hospitalization and changing trends in renal function.Results:Among 276 eligible recipients, 24.6% had eGFR <60 ml/min/1.73 m n 2. Compared with eGFR ≥90 ml/min/1.73 mn 2, one-year mortality risk ratios after adjusting the model were 1.78 (M3, 95% confidence interval [CI]: 1.31-3.39) and 2.74 (M4, 95%CI: 1.41-5.32) respectively. Moreover, mortality risk ratio, postoperative utilization rate of CRRT and hospitalization cycle of M4 group significantly increased compared with other groups. The median eGFR level was 73 ml/min/1.73 mn 2 pre-transplantation. It decreased to 61 ml/min/1.73 mn 2 at Month 3 and then gradually stabilized. And eGFR ≥60 and eGFR <60 ml/min/1.73 m n 2 had similar trends.n Conclusions:Prior to heart transplantation, estimated eGFR is an independent predictor of short-term survival after OHT. It may gradually deteriorate at Month 3 post-transplantation. After proper treatments, eGFR of some recipients improves at Month 3.