Incidence of end-stage renal disease after heart transplantation and effect of its treatment on survival.

Abstract

AIMS:

Many heart transplant recipients will develop end-stage renal disease in the post-operative course. The aim of this study was to identify the long-term incidence of end-stage renal disease, determine its risk factors, and investigate what subsequent therapy was associated with the best survival.

METHODS AND RESULTS:

A retrospective, single-centre study was performed in all adult heart transplant patients from 1984 to 2016. Risk factors for end-stage renal disease were analysed by means of multivariable regression analysis and survival by means of Kaplan-Meier. Of 685 heart transplant recipients, 71 were excluded: 64 were under 18 years of age and seven were re-transplantations. During a median follow-up of 8.6 years, 121 (19.7%) patients developed end-stage renal disease: 22 received conservative therapy, 80 were treated with dialysis (46 haemodialysis and 34 peritoneal dialysis), and 19 received a kidney transplant. Development of end-stage renal disease (examined as a time-dependent variable) inferred a hazard ratio of 6.45 (95% confidence interval 4.87-8.54, P < 0.001) for mortality. Tacrolimus-based therapy decreased, and acute kidney injury requiring renal replacement therapy increased the risk for end-stage renal disease development (hazard ratio 0.40, 95% confidence interval 0.26-0.62, P < 0.001, and hazard ratio 4.18, 95% confidence interval 2.30-7.59, P < 0.001, respectively). Kidney transplantation was associated with the best median survival compared with dialysis or conservative therapy: 6.4 vs. 2.2 vs. 0.3 years (P < 0.0001), respectively, after end-stage renal disease development.

CONCLUSIONS:

End-stage renal disease is a frequent complication after heart transplant and is associated with poor survival. Kidney transplantation resulted in the longest survival of patients with end-stage renal disease.

• Authors: Stefan Roest, Dennis A Hesselink, Dominika Klimczak-Tomaniak, Isabella Kardys, Kadir Caliskan, Jasper J Brugts, Alexander P W M Maat, Michał Ciszek, Alina A Constantinescu, Olivier C Manintveld
• Journal: ESC heart failure (ESC Heart Fail) Vol. 7 Issue 2 Pg. 533-541 (04 2020) ISSN: 2055-5822 [Electronic] England
• PMID: 32022443 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Topics

• Adolescent
• Adult
• Heart Transplantation
• Humans
• Incidence
• Kidney Failure, Chronic (epidemiology)
• Renal Dialysis
• Retrospective Studies