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Abstract: TH-PO1181

Patients with Pretransplant eGFR < 20 mL/min Are at High Risk for ESRD Within 2 Years of an Isolated Heart Transplant

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Kumar, Abhishek, University of Vermont, Burlington, Vermont, United States
  • Thomas, Christie P., University of Iowa, Iowa City, Iowa, United States
Background

Preexistent advanced chronic kidney disease can progress to ESRD after heart transplantation. We examined if risk of ESRD and mortality was different in isolated heart transplant patients with a pre-transplant eGFR between 20 and 30 ml/min as compared to an eGFR <20 ml/min. We chose a cutoff between groups of 20 ml/min as, at this level of kidney function, patients qualify for a kidney transplant as per current kidney allocation rules.

Methods

We analyzed UNOS heart transplant data in adults receiving an isolated heart transplant between 2000 and 2015 who had a pretransplant eGFR ≤30 ml/min. Survival analysis was used to generate Kaplan-Meier curves. Results were adjusted for multiple confounding factors.

Results

We had 1093 patients with a pretransplant eGFR of ≤30 ml/min in our cohort. Of these 915 patients had data on a renal event (ESRD and/or kidney transplant) and 1057 had data on mortality. Incidence and hazard ratios for renal events and mortality are shown in Table 1. Kaplan Meier curve for renal event is shown in Figure 1.

Conclusion

Patients with an eGFR <20 ml/min had 61% higher risk of renal event than the group with eGFR between 20-30 ml/min. 50% of the renal events in the cohort with an initial eGFR <20 ml/min, occurred within the first two years post transplant. 76.4% of patients with an eGFR of 20-30 ml/min did not develop ESRD or need a kidney transplant over a 15 year followup period. These observations may help refine criteria for patients who could benefit from a combined heart kidney transplant rather than having to face the need for ESRD care with uncertain access to a kidney transplant within 2 years of their heart transplant.

Table 1. Event rates and hazard ratios

Figure 1. Kaplan Meier Renal Survival