Abstract: TH-PO1132
Presence of Renal Dysfunction Even at the Time of Listing Predicts Risk of ESRD in Isolated Heart Transplant Patients
Session Information
- Transplantation: Clinical - Predictors of Outcomes - Biomarkers and Beyond
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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
Presence of chronic kidney disease (CKD) at the time of heart transplant is an independent predictor of post-transplant ESRD (end stage renal disease) and all-cause mortality. We wished to look at the effect of the presence and severity of CKD at the time of listing on post-heart transplant ESRD and mortality.
Methods
We analyzed 2000-2015 UNOS heart transplant data. Adults receiving first isolated heart transplant, who were not on dialysis were included in study. We divided our cohort into four clinically relevant groups based on their listing eGFR (<30 ml/min, 30-44 ml/min, 45-59 ml/min and ≥60 ml/min). Survival analysis was used to generate Kaplan-Meier curves. Results were adjusted for multiple confounding factors.
Results
We had 27,169 patients in our cohort. In the follow up period there were 7595 deaths and 2335 patients reached ESRD (Table 1). Kaplan-Meier curves for ESRD are shown in Figure 1.
Conclusion
Our findings shows that risk of renal replacement therapy post heart transplant increases with worsening eGFR at listing even after adjusting for multiple confounders with the highest risk in the group with eGFR <30 ml/min. This information may help identify patients for combined heart-kidney transplant in a more reasonable time frame.
Risk of post heart transplant ESRD by listing eGFR
| eGFR at time of listing | ESRD N (%) | Adj hazard ratio with p value | Mortality N (% | Adj hazard ratio with p value |
| eGFR <30 | 157 (21.7) | 2.77 (p<0.001) | 284 (39.6) | 1.10 (p=0.148) |
| eGFR 30-44 | 572 (15.7) | 2.16 (p<0.001) | 1289 (35.5) | 1.11 (p<0.001) |
| eGFR 45-60 | 617 (10.1) | 1.40 (p<0.001) | 1961 (32.4) | 1.05 (p=0.092) |
| eGFR > 60 | 989 (7) | 1 | 4061 (28.9) | 1 |
Figure 1: Kaplan-Meier estimate for renal survival