Estimated Glomerular Filtration Rate at Transplant Listing and Other Predictors of Post-Heart Transplant Mortality and the Development of ESRD.
Adult
Aged
Databases, Factual
Disease Progression
Female
Glomerular Filtration Rate
Heart Failure
/ diagnosis
Heart Transplantation
/ adverse effects
Humans
Kidney Failure, Chronic
/ diagnosis
Male
Middle Aged
Predictive Value of Tests
Renal Insufficiency, Chronic
/ diagnosis
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Waiting Lists
Journal
Transplantation
ISSN: 1534-6080
Titre abrégé: Transplantation
Pays: United States
ID NLM: 0132144
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
pubmed:
7
2
2020
medline:
10
2
2021
entrez:
7
2
2020
Statut:
ppublish
Résumé
Elevated serum creatinine at the time of heart transplant is an independent predictor of posttransplant end-stage renal disease (ESRD) and mortality. Patients who are at risk of ESRD should be identified before transplantation. We looked at the severity of CKD at the time of waitlisting on posttransplant ESRD and mortality. We analyzed the United Network of Organ Sharing transplant database from 2000 to 2017. Adults receiving their first heart transplant, and not on dialysis, were included in study. We divided our cohort into 4 groups based on their listing estimated glomerular filtration (eGFR) as well as based on their eGFR at the time of transplant. Primary outcome was all cause mortality and secondary outcome was ESRD. Compared with the patients on waitlist eGFR ≥60 mL/min/1.73 m, the adjusted subdistribution hazard for ESRD was 1.41 (confidence interval [CI], 1.2-1.5), 2.15 (CI, 1.9-2.4), and 2.91 (CI, 2.4-3.5) in the patient groups with eGFR of 45-59, 30-44, and <30 mL/min/1.73 m, respectively. Despite the highest risk of ESRD with the lowest baseline eGFR group, there was a substantial increase in eGFR seen during follow-up with a mean gain of 11 mL/min by year 15 compared with a mean loss of 10 mL/min in the highest eGFR group. Compared with the patients on waitlist eGFR ≥60 mL/min/1.73m, the adjusted hazard ratio for mortality was 1.04 (0.98-1.11), 1.07 (1.00-1.15), and 1.04 (0.91-1.19) in the patient groups with eGFR of 45-59, 30-44, and <30 mL/min/1.73m, respectively. Our findings show that risk of ESRD post-heart transplant increases with worsening eGFR at waitlisting even after adjusting for multiple confounders.
Sections du résumé
BACKGROUND
Elevated serum creatinine at the time of heart transplant is an independent predictor of posttransplant end-stage renal disease (ESRD) and mortality. Patients who are at risk of ESRD should be identified before transplantation. We looked at the severity of CKD at the time of waitlisting on posttransplant ESRD and mortality.
METHODS
We analyzed the United Network of Organ Sharing transplant database from 2000 to 2017. Adults receiving their first heart transplant, and not on dialysis, were included in study. We divided our cohort into 4 groups based on their listing estimated glomerular filtration (eGFR) as well as based on their eGFR at the time of transplant. Primary outcome was all cause mortality and secondary outcome was ESRD.
RESULTS
Compared with the patients on waitlist eGFR ≥60 mL/min/1.73 m, the adjusted subdistribution hazard for ESRD was 1.41 (confidence interval [CI], 1.2-1.5), 2.15 (CI, 1.9-2.4), and 2.91 (CI, 2.4-3.5) in the patient groups with eGFR of 45-59, 30-44, and <30 mL/min/1.73 m, respectively. Despite the highest risk of ESRD with the lowest baseline eGFR group, there was a substantial increase in eGFR seen during follow-up with a mean gain of 11 mL/min by year 15 compared with a mean loss of 10 mL/min in the highest eGFR group. Compared with the patients on waitlist eGFR ≥60 mL/min/1.73m, the adjusted hazard ratio for mortality was 1.04 (0.98-1.11), 1.07 (1.00-1.15), and 1.04 (0.91-1.19) in the patient groups with eGFR of 45-59, 30-44, and <30 mL/min/1.73m, respectively.
CONCLUSIONS
Our findings show that risk of ESRD post-heart transplant increases with worsening eGFR at waitlisting even after adjusting for multiple confounders.
Identifiants
pubmed: 32028343
doi: 10.1097/TP.0000000000003159
pii: 00007890-202011000-00035
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2444-2452Commentaires et corrections
Type : CommentIn
Références
Ojo AO. Renal disease in recipients of nonrenal solid organ transplantation. Semin Nephrol. 2007; 27:498–507
Canales M, Youssef P, Spong R, et al. Predictors of chronic kidney disease in long-term survivors of lung and heart-lung transplantation. Am J Transplant. 2006; 6:2157–2163
Thomas HL, Banner NR, Murphy CL, et al.; Steering Group of the UK Cardiothoracic Transplant Audit. Incidence, determinants, and outcome of chronic kidney disease after adult heart transplantation in the United Kingdom. Transplantation. 2012; 93:1151–1157
Giusto M, Berenguer M, Merkel C, et al. Chronic kidney disease after liver transplantation: pretransplantation risk factors and predictors during follow-up. Transplantation. 2013; 95:1148–1153
González-Vílchez F, Arizón JM, Segovia J, et al. Chronic renal dysfunction in maintenance heart transplant patients: the ICEBERG study. Transplant Proc. 2014; 46:14–20
Delgado JF, Crespo-Leiro MG, Gómez-Sánchez MA, et al. Risk factors associated with moderate-to-severe renal dysfunction among heart transplant patients: results from the CAPRI study. Clin Transplant. 2010; 24:E194–E200
Bloom RD, Reese PP. Chronic kidney disease after nonrenal solid-organ transplantation. J Am Soc Nephrol. 2007; 18:3031–3041
Lund LH, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: thirty-second official adult heart transplantation report–2015; focus theme: early graft failure. J Heart Lung Transplant. 2015; 34:1244–1254
Habib PJ, Patel PC, Hodge D, et al. Pre-orthotopic heart transplant estimated glomerular filtration rate predicts post-transplant mortality and renal outcomes: an analysis of the UNOS database. J Heart Lung Transplant. 2016; 35:1471–1479
Navarro-Manchón J, Martínez-Dolz L, Almenar Bonet L, et al. Predictors of renal dysfunction at 1 year in heart transplant patients. Transplantation. 2010; 89:977–982
Ronco C, Di Lullo L. Cardiorenal syndrome. Heart Fail Clin. 2014; 10:251–280
Kolsrud O, Ricksten SE, Holmberg E, et al. Measured and not estimated glomerular filtration rate should be used to assess renal function in heart transplant recipients. Nephrol Dial Transplant. 2016; 31:1182–1189
Ruebner R, Goldberg D, Abt PL, et al. Risk of end-stage renal disease among liver transplant recipients with pretransplant renal dysfunction. Am J Transplant. 2012; 12:2958–2965
Sharma P, Goodrich NP, Schaubel DE, et al. Patient-specific prediction of ESRD after liver transplantation. J Am Soc Nephrol. 2013; 24:2045–2052
Meier-Kriesche HU, Port FK, Ojo AO, et al. Effect of waiting time on renal transplant outcome. Kidney Int. 2000; 58:1311–1317