Abstract: TH-PO931

De Novo Heart Failure after Kidney Transplantation: Trends in Incidence and Outcomes

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Lenihan, Colin R., Stanford University School of Medicine, Palo Alto, California, United States
  • Liu, Sai, Stanford University, Santa Clara, California, United States
  • Deswal, Anita, Baylor College of Medicine, Houston, Texas, United States
  • Montez-Rath, Maria E., Stanford University School of Medicine, Palo Alto, California, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
Background

Older US data indicate that heart failure (HF) occurs in 18% of patients in the 3-years following kidney transplant. Herein, we sought to explore secular trends in the incidence of de novo post-kidney transplant HF and its associated mortality.

Methods

We identified adult patients who underwent their first kidney transplant in the US between 1998 and 2010. We required that patients had ≥6 months of continuous Medicare parts A and B coverage prior to transplant. HF diagnosis was ascertained using ICD-9 diagnosis codes. Patients with a diagnosis of HF prior to transplant were excluded from the cohort. Cox models were employed to examine secular trends in 1) de novo post-kidney transplant HF and 2) mortality following de novo post-transplant HF diagnosis. Calendar year of transplant was the primary exposure of interest.

Results

48,771 patients met the study inclusion criteria. Age at transplant, BMI, dialysis vintage and the prevalence of several baseline comorbidities increased between 1998 and 2010. 7269 patients developed HF within 3 years of kidney transplantation with a median time to HF of 0.76 years and an incidence rate of 6.2 per 100 person-years. When adjusted for demographic, comorbid, and transplant-related characteristics the incidence of de novo post-transplant HF was 31% lower for patients transplanted in the year 2010 compared to those transplanted in 1998 (HR 0.69; CI 0.60-0.79; Figure 1). However, we observed no temporal trend in adjusted mortality following de novo post-transplant HF diagnosis.

Conclusion

When adjusted for demographic and clinical characteristics, the incidence of de novo post-kidney transplant heart failure has declined significantly during the period from 1998 to 2010, with no apparent change in subsequent mortality.

Figure 1. Unadjusted and adjusted relative hazards of de novo post-kidney transplant heart failure by calendar year of transplant

Funding

  • NIDDK Support