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Kidney Week

Abstract: TH-PO934

Changes in Renal Function in Patients Bridged to Heart Transplantation with a Continuous-Flow Left Ventricular Assist Device (LVAD): Analysis of 2480 Patients

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Elfadawy, Nissreen, Division of Nephrology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
  • Al-Kindi, Sadeer, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
  • Huml, Anne M., Division of Nephrology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
  • Oliveira, Guilherme H, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
Background

Left ventricular assist devices (LVADs) have become an established option for patients with end-stage heart failure. The impact of LVAD on renal function is not widely studied and remain controversial. Objectives: The aim of this study was to determine the impact of LVAD implantation on renal function in patients with end-stage heart failure and discover risk factors associated with renal dysfunction in these patients

Methods

We used the United Network Of Organ Sharing registry (UNOS) to identify adult patients who are bridged to heart transplantation with HeartMate II or Heartware continuous-flow LVADs from 2007-2015. We excluded patient on dialysis, intra-aortic balloon pumps, extra-corporeal membrane oxygenation, or inotropes. Calculated glomerular filtration rate (GFR) using CKD-EPI formula was assessed at listing and prior to heart transplantation. Significant change in GFR at time of transplantation was defined ≥10 ml/min/1.73 m2 change from baseline. Predictors for worsening in GFR were examined by multivariable logistic regression model.

Results

A total of 2480 patients were included, mean age 54±12 years, 80% were male, 36% were status 1A, and 45% had ischemic cardiomyopathy. Mean time on wait-list was 192 days. Mean baseline GFR was 76±26, mean GFR at time of HTx was 72±26 (p<0.001). Overall, 31% (n=788) showed significant worsening in GFR. Risk factors for worsening GFR were older age (1.03 [1.02-1.04] per year, P<0.001), longer time on wait-list (1.001 [1.000-1.001] per day, P=0.001), higher PCWP (1.02 [1.01-1.03] per 1 mmHg, P<0.001), and higher baseline GFR (1.04 [1.03-1.04] per 1 ml/min/1.73 m2, P<0.001)

Conclusion

Approximately one third of candidates for heart transplantation experience significant GFR worsening after LVAD implantation. Older age, longer wait time, and higher baseline GFR are significant risk factors