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Comparative Study
. 2013 Jun;13(6):1566-75.
doi: 10.1111/ajt.12197.

Outcomes after kidney transplantation of patients previously diagnosed with atrial fibrillation

C R Lenihan  1 , M E Montez-Rath, J D Scandling, M P Turakhia, W C Winkelmayer
Affiliations
Comparative Study

Outcomes after kidney transplantation of patients previously diagnosed with atrial fibrillation

C R Lenihan et al. Am J Transplant. 2013 Jun.

Abstract

Little is known about the prevalence and outcomes of patients with atrial fibrillation/flutter (AF) who receive a kidney transplant. We identified all patients who had >1 year of uninterrupted Medicare A+B coverage before receiving their first kidney transplant (1997-2009). The presence of pretransplant AF was ascertained from diagnosis codes in Medicare physician claims. We studied the posttransplant outcomes of death, all-cause graft failure, death-censored graft failure and stroke using multivariable Cox regression. Of 62 706 eligible first kidney transplant recipients studied, 3794 (6.4%) were diagnosed with AF prior to kidney transplant. Over a mean follow up of 4.9 years, 40.6% of AF patients and 24.9% without AF died. All-cause and death-censored graft failure were 46.8% and 16.5%, respectively, in the AF group and 36.4% and 19.5%, respectively, in those without AF. Ischemic stroke occurred in 2.8% of patients with and 1.6% of patients without AF. In patients with AF, multivariable-adjusted hazard ratios (95% confidence intervals) for death, graft failure, death-censored graft failure and ischemic stroke were 1.46 (1.38-1.54), 1.41 (1.34-1.48), 1.26 (1.15-1.37) and 1.36 (1.10-1.68), respectively. Pre-existing AF is associated with poor posttransplant outcomes. Special attention should be paid to AF in pretransplant evaluation, counseling and risk stratification of kidney transplant candidates.

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Figures

Figure 1
Figure 1
Cohort Flow Chart
Figure 2
Figure 2. Kaplan-Meier Product Limit Estimates of Study Outcomes
AF+: Patients with atrial fibrillation. AF−: Patients without atrial fibrillation. Incidence computed by the Kaplan-Meier method.
Figure 2
Figure 2. Kaplan-Meier Product Limit Estimates of Study Outcomes
AF+: Patients with atrial fibrillation. AF−: Patients without atrial fibrillation. Incidence computed by the Kaplan-Meier method.
Figure 2
Figure 2. Kaplan-Meier Product Limit Estimates of Study Outcomes
AF+: Patients with atrial fibrillation. AF−: Patients without atrial fibrillation. Incidence computed by the Kaplan-Meier method.
Figure 2
Figure 2. Kaplan-Meier Product Limit Estimates of Study Outcomes
AF+: Patients with atrial fibrillation. AF−: Patients without atrial fibrillation. Incidence computed by the Kaplan-Meier method.
Figure 3
Figure 3. Unadjusted and Adjusted Hazard Ratios for Study Outcomes
Stratified Cox analysis with multiple imputation to handle missing data. All models stratified by Year of transplant. Model 1 is adjusted for age, sex, and race. Model 2 is additionally adjusted for BMI at transplant, cause of ESRD, dialysis vintage, dialysis modality, skilled nursing facility utilization indicator, number of hospital days, number of non-nephrology clinic visits, previous solid organ transplant, and all comorbidities. Model 3 is additionally adjusted for patient blood type, panel reactive antibody, donor age, donor sex, transplant type, number of HLA mismatches, and cold ischemia time. Ischemic stroke includes events related to death from any kind of stroke.
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