The impact of changes in renal function during waitlist time on outcomes after heart transplantation

Area of Science:

• Cardiology
• Nephrology
• Transplantation Medicine

Background:

• Renal function changes during the waitlist period can influence outcomes for patients awaiting orthotopic heart transplantation (OHT).
• Understanding the impact of evolving kidney function on post-transplant results is crucial for patient management.

Purpose of the Study:

• To evaluate how changes in renal function, specifically chronic kidney disease (CKD) stage, affect post-OHT outcomes.
• To determine if alterations in estimated glomerular filtration rate (eGFR) or CKD stage during the waitlist predict 1-year mortality.

Main Methods:

• Analysis of adult patients undergoing isolated OHT from the United Network for Organ Sharing registry (2010-2020).
• Stratification of patients based on CKD stage changes (improved, worsened, unchanged) between listing and transplantation.
• Utilized univariate analysis and multivariable Cox regression to assess the predictive value of eGFR and CKD stage changes on 1-year mortality.

Main Results:

• Approximately 20% of patients experienced improved CKD, 20% worsened, and 60% remained unchanged.
• Temporary mechanical circulatory support (MCS) correlated with improved CKD, while durable MCS was linked to worsened CKD.
• Worsened CKD stage predicted a higher likelihood of post-OHT dialysis (13.2%) compared to improved CKD (9.4%).
• No significant risk-adjusted effect of eGFR or CKD stage changes on 1-year post-OHT mortality was observed.

Conclusions:

• Significant proportions of OHT candidates experience changes in CKD stage during the waitlist period.
• Worsening CKD stage is a predictor of increased need for post-transplant dialysis.
• Changes in CKD stage between listing and OHT do not appear to impact 1-year post-transplant survival.