Cohort study: "Outcomes of kidney transplantation in patients with prosthetic heart valves"
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Updated: Oct 23, 2025
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Hajar Ouahmi1,2, Pamela Moceri2,3, Kevin Zorzi1,2
1Nephrology, Dialysis and Transplantation Department, Pasteur 2 Hospital, Nice University Hospital, Nice, France.
Insights
Kidney transplant patients with prosthetic heart valves (PHVs) face higher mortality, particularly those with mechanical valves. Graft survival is similar, but overall survival is significantly reduced in PHV recipients.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- The number of kidney transplant candidates with prosthetic heart valves (PHVs) is increasing.
- Outcomes of kidney transplantation in patients with PHVs are not well-established.
- This study is the first to report post-transplant outcomes in kidney transplant recipients with PHVs.
Purpose of the Study:
- To compare post-transplant outcomes in kidney transplant recipients with left-sided PHVs versus recipients without PHVs.
- To identify risk factors associated with mortality in kidney transplant recipients with PHVs.
Main Methods:
- A matched cohort study was conducted using data from the prospective DIVAT cohort.
- 92 kidney transplant recipients with PHVs were compared to 276 matched recipients without PHVs.
- Matching criteria included age, dialysis time, initial disease, pretransplant donor-specific antibodies, diabetes, and cardiovascular events.
Main Results:
- Patients with PHVs experienced higher rates of delayed graft function and postoperative bleeding.
- Kidney graft survival was similar between groups.
- Five-year overall survival was significantly lower in patients with PHVs (68.5%) compared to those without (87.9%).
- Deaths from infection, endocarditis, and bleeding were more frequent in the PHV group.
- Mechanical valves, but not bioprosthetic valves, were an independent risk factor for mortality.
Conclusions:
- Kidney transplant recipients with PHVs exhibit high post-transplant mortality rates.
- Mechanical prosthetic heart valves significantly increase the risk of post-transplant mortality.
- Bioprosthetic valves did not show an independent association with increased mortality risk.
Abstract:
The number of kidney transplant candidates with prosthetic heart valves (PHVs) is increasing. Yet, outcomes of kidney transplantation in these patients are still unclear. This is the first report of post-transplant outcomes in patients with PHVs at time of kidney transplantation. We conducted a matched cohort study among recipients from the multicentric and prospective DIVAT cohort to compare the outcomes in patients with left-sided PHVs at time of transplantation and a group of recipients without PHV matched according to age, dialysis time, initial disease, pretransplant DSA, diabetes, and cardiovascular events. Of 23 018 patients, 92 patients with PHVs were included and compared to 276 patients without PHV. Delayed graft function and postoperative bleeding occurred more frequently in patients with PHVs. Kidney graft survival was similar between groups. 5-year overall survival was 68.5% in patients with PHV vs. 87.9% in patients without PHV [HR, 2.72 (1.57-4.70), P = 0.0004]. Deaths from infection, endocarditis, and bleeding were more frequent in patients with PHV. Mechanical valves, but not bioprosthetic valves, were independent risk factors for mortality [HR, 2.89 (1.68-4.97), P = 0.0001]. Patients with PHV have high mortality rates after kidney transplantation. These data suggest that mechanical valves, but not biological valves, increase risks of post-transplant mortality.
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