Outcomes in Patients With LVADs Undergoing Simultaneous Heart-Kidney Transplantation
Copyright © 2022 Elsevier Inc. All rights reserved..
BACKGROUND: Multiple studies have shown better outcomes for simultaneous heart-kidney transplant (sHKT) than for isolated orthotopic heart transplant (iOHT) in recipients with chronic kidney disease (CKD). However, outcomes in patients supported by durable left ventricular assist devices (LVADs) have not been well studied.
METHODS: Patients with durable LVADs and stage 3 or higher CKD (eGFR < 60 mL/min/1.73 m2) undergoing iOHT or sHKT between 2008 and 2020 were identified from the United Network for Organ Sharing registry. A Kaplan-Meier survival analysis with associated log-rank test was conducted to compare post-transplant survival rates. Multivariable modeling was used to identify risk-adjusted predictors of 1 year post-transplant mortality.
RESULTS: We identified 4375 patients; 366 underwent sHKT, and 4009 underwent iOHT. The frequency of sHKT increased during the study period. The 1-year post-transplant survival rate was worse in patients after sHKT than in patients after iOHT (80.3% vs 88.3%; P < 0.001) and persisted up to 5 years post-transplant (P = 0.001). sHKT recipients were more likely to require dialysis after transplantation and had longer hospital lengths of stay (P < 0.001). Multivariable analysis showed that sHKT remained an independent risk factor for mortality at 1 year (OR 1.58; P = 0.002).
CONCLUSIONS: sHKT is becoming more common in patients with durable LVADs. Compared with iOHT, patients with sHKTs have worse short- and long-term survival rates and are more likely to require post-transplant dialysis.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:28 |
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| Enthalten in: |
Journal of cardiac failure - 28(2022), 11 vom: 15. Nov., Seite 1584-1592 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Atkins, Jessica [VerfasserIn] |
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| Links: |
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| Themen: |
Chronic kidney disease |
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| Anmerkungen: |
Date Completed 15.11.2022 Date Revised 06.12.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.cardfail.2022.04.016 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM341200875 |
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| 100 | 1 | |a Atkins, Jessica |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Outcomes in Patients With LVADs Undergoing Simultaneous Heart-Kidney Transplantation |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Multiple studies have shown better outcomes for simultaneous heart-kidney transplant (sHKT) than for isolated orthotopic heart transplant (iOHT) in recipients with chronic kidney disease (CKD). However, outcomes in patients supported by durable left ventricular assist devices (LVADs) have not been well studied | ||
| 520 | |a METHODS: Patients with durable LVADs and stage 3 or higher CKD (eGFR < 60 mL/min/1.73 m2) undergoing iOHT or sHKT between 2008 and 2020 were identified from the United Network for Organ Sharing registry. A Kaplan-Meier survival analysis with associated log-rank test was conducted to compare post-transplant survival rates. Multivariable modeling was used to identify risk-adjusted predictors of 1 year post-transplant mortality | ||
| 520 | |a RESULTS: We identified 4375 patients; 366 underwent sHKT, and 4009 underwent iOHT. The frequency of sHKT increased during the study period. The 1-year post-transplant survival rate was worse in patients after sHKT than in patients after iOHT (80.3% vs 88.3%; P < 0.001) and persisted up to 5 years post-transplant (P = 0.001). sHKT recipients were more likely to require dialysis after transplantation and had longer hospital lengths of stay (P < 0.001). Multivariable analysis showed that sHKT remained an independent risk factor for mortality at 1 year (OR 1.58; P = 0.002) | ||
| 520 | |a CONCLUSIONS: sHKT is becoming more common in patients with durable LVADs. Compared with iOHT, patients with sHKTs have worse short- and long-term survival rates and are more likely to require post-transplant dialysis | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Left ventricular assist device | |
| 650 | 4 | |a chronic kidney disease | |
| 650 | 4 | |a heart-kidney transplant | |
| 650 | 4 | |a orthotopic heart transplant | |
| 700 | 1 | |a Hess, Nicholas R |e verfasserin |4 aut | |
| 700 | 1 | |a Fu, Sheng |e verfasserin |4 aut | |
| 700 | 1 | |a Read, Jacob M |e verfasserin |4 aut | |
| 700 | 1 | |a Hajj, Jennifer M |e verfasserin |4 aut | |
| 700 | 1 | |a Ramu, Bhavadharini |e verfasserin |4 aut | |
| 700 | 1 | |a Silverman, Daniel N |e verfasserin |4 aut | |
| 700 | 1 | |a Inampudi, Chakradhari |e verfasserin |4 aut | |
| 700 | 1 | |a Vanbakel, Adrian B |e verfasserin |4 aut | |
| 700 | 1 | |a Hashmi, Z A |e verfasserin |4 aut | |
| 700 | 1 | |a Pope, Nicholas H |e verfasserin |4 aut | |
| 700 | 1 | |a Witer, Lucas P |e verfasserin |4 aut | |
| 700 | 1 | |a Kanwar, Manreet K |e verfasserin |4 aut | |
| 700 | 1 | |a Sauer, Andrew J |e verfasserin |4 aut | |
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| 700 | 1 | |a Kilic, Arman |e verfasserin |4 aut | |
| 700 | 1 | |a Tedford, Ryan J |e verfasserin |4 aut | |
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