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Published on: May 7, 2019

Poor prognosis of heart transplant patients with end-stage renal failure

Emmanuel Villar1, Pascale Boissonnat, Laurent Sebbag

  • 1Department of Nephrology, Dialysis and Transplantation, Hospices Civils de Lyon, Lyon Sud Hospital, Claude Bernard University, France. emmanuel.villar@chu-lyon.fr

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|February 3, 2007
PubMed

Insights

Heart transplant (HT) patients with chronic kidney disease (CKD) requiring dialysis for end-stage renal failure (ESRF) have significantly poorer survival rates compared to non-HT patients. Renal transplant is recommended as the preferred ESRF treatment for HT recipients.

Area of Science:

  • Nephrology
  • Cardiology
  • Transplantation Medicine

Background:

  • Chronic kidney disease (CKD) and end-stage renal failure (ESRF) are significant complications following heart transplantation (HT).
  • Comparing survival outcomes for heart transplant (HT) recipients versus non-HT patients initiating dialysis is crucial for understanding post-transplant complications.

Purpose of the Study:

  • To compare the survival rates of heart transplant (HT) patients with end-stage renal failure (ESRF) undergoing dialysis against non-HT patients on dialysis.
  • To identify causes of ESRF and mortality in HT patients post-dialysis initiation.

Main Methods:

  • A cohort of 539 newly dialyzed patients between 1995 and 2005 were prospectively followed.
  • Multivariate survival analysis using the Cox model was performed, adjusting for baseline characteristics.

Main Results:

  • Heart transplant (HT) patients were younger at dialysis initiation (58.6 vs. 63.0 years).
  • Calcineurin inhibitor nephrotoxicity was the primary cause of ESRF in 47.6% of HT patients.
  • Adjusted hazard ratio for death in HT vs. non-HT patients was 2.27 (P=0.003), with sudden death being more common in HT patients (33.3% vs. 10.4%).
  • Five HT patients received renal transplants and survived; only one of 16 remaining HT patients on dialysis survived.

Conclusions:

  • Heart transplant (HT) patients reaching end-stage renal failure (ESRF) exhibit poor survival on dialysis compared to non-HT patients.
  • Improved renal function management and evaluation of non-nephrotoxic immunosuppressants are necessary for CKD patients post-HT.
  • Renal transplantation should be considered the optimal ESRF treatment for HT recipients.
Abstract

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