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. 2023 Jun;42(6):795-806.
doi: 10.1016/j.healun.2023.01.004. Epub 2023 Jan 20.

Clinical trends, risk factors, and temporal effects of post-transplant dialysis on outcomes following orthotopic heart transplantation in the 2018 United States heart allocation system

Yeahwa Hong  1 , Nicholas R Hess  2 , Luke A Ziegler  2 , Gavin W Hickey  3 , Jessica H Huston  3 , Michael A Mathier  3 , Dennis M McNamara  3 , Mary E Keebler  3 , David J Kaczorowski  4
Affiliations

Clinical trends, risk factors, and temporal effects of post-transplant dialysis on outcomes following orthotopic heart transplantation in the 2018 United States heart allocation system

Yeahwa Hong et al. J Heart Lung Transplant. 2023 Jun.

Abstract

Background: This study evaluated the current clinical trends, risk factors, and temporal effects of post-transplant dialysis on outcomes following orthotopic heart transplantation after the 2018 United States adult heart allocation policy change.

Methods: The United Network for Organ Sharing (UNOS) registry was queried to analyze adult orthotopic heart transplant recipients after the October 18, 2018 heart allocation policy change. The cohort was stratified according to the need for post-transplant de novo dialysis. The primary outcome was survival. Propensity score-matching was performed to compare the outcomes between 2 similar cohorts with and without post-transplant de novo dialysis. The impact of post-transplant dialysis chronicity was evaluated. Multivariable logistic regression was performed to identify risk factors for post-transplant dialysis.

Results: A total of 7,223 patients were included in this study. Out of these, 968 patients (13.4%) developed post-transplant renal failure requiring de novo dialysis. Both 1-year (73.2% vs 94.8%) and 2-year (66.3% vs 90.6%) survival rates were lower in the dialysis cohort (p < 0.001), and the lower survival rates persisted in a propensity-matched comparison. Recipients requiring only temporary post-transplant dialysis had significantly improved 1-year (92.5% vs 71.6%) and 2-year (86.6 % vs 52.2%) survival rates compared to the chronic post-transplant dialysis group (p < 0.001). Multivariable analysis demonstrated low pretransplant estimated glomerular filtration (eGFR) and bridge with extracorporeal membrane oxygenation (ECMO) were strong predictors of post-transplant dialysis.

Conclusions: This study demonstrates that post-transplant dialysis is associated with significantly increased morbidity and mortality in the new allocation system. Post-transplant survival is affected by the chronicity of post-transplant dialysis. Low pretransplant eGFR and ECMO are strong risk factors for post-transplant dialysis.

Keywords: adverse events; dialysis; orthotopic heart transplantation; renal failure; survival.

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Conflict of interest statement

Disclosure statement Dr. Kaczorowski received consultant and speaking fees for Medtronic and Abiomed. There are no direct conflicts of interest as it relates to this manuscript.

Figures

Figure 1
Figure 1
Unadjusted Kaplan-Meier estimates for survival following heart transplantation stratified by post-transplant dialysis requirements in unmatched cohorts.
Figure 2
Figure 2
Comparison of survival stratified by post-transplant dialysis in propensity score-matched cohorts.
Figure 3
Figure 3
Kaplan-Meier estimates for survival following heart transplantation. (A) Comparison of survival stratified by post-transplant dialysis requirements and dialysis chronicity. (B) Comparison of survival stratified by post-transplant dialysis requirements and dialysis chronicity with conditional 90-day survival. (C) Comparison of survival stratified by pretransplant dialysis and post-transplant de novo dialysis.
See this image and copyright information in PMC

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