['Survival after cardiac transplantation has not changed over the last 10 years. Our objective was to identify risk factors for 30-day mortality after cardiac transplantation with particular reference to focusing on the impact of pre-existing renal dysfunction.', 'We analyzed the data of all 1,180 patients who received a first heart transplant in the 8 adult transplant centers in the United Kingdom between April 1996 and March 2002 using the UK Cardiothoracic Transplant Audit database. Renal function at registration and transplantation was determined by calculation of creatinine clearance (CrCl) according to the Cockcroft-Gault formula.', 'Multivariate analysis showed that ventilator dependence pre-transplantation and cold ischemia time >4 hours had the highest association with 30-day mortality, followed by CrCl </=50 ml/min. Patients with a CrCl </=50 ml/min on day of transplantation had a significantly higher 30-day mortality compared to patients with CrCl >50 ml/min (19.7% vs 9.5%; p < 0.01). The change in CrCl between registration and transplantation was not related to mean CrCl or waiting time. In 67 of the patients with a CrCl >50 ml/min at registration, CrCl was reduced to </=50 ml/min on day of transplantation (30-day mortality 16.7%).'] Does pre-existing renal failure double 30-day mortality after heart transplantation?