Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Background: Advance Heart Disease may result in cardio-renal syndrome and thereby cause renal insufficiency. These patients (pts) can be optimized with medical therapy with reversal of the cardio-renal syndrome. These pts will do well with heart alone transplantation. When to perform a combined heart-kidney transplant (HKTx) is not clear. Glomerular filtration rate (GFR) <40 has been published as a guideline for when to perform HKTx. It has been reported that pts with mechanical circulatory support (MCS) have more kidney insufficiency immediately after heart transplantation. This study is to assess whether borderline renal function in MCS pts results in end stage renal disease (ESRD). For these pts, combined HKTx may be a better choice.
Methods: Between 2010 and 2014 we assessed 150 heart transplant pts supported by MCS and had various creatinine levels. GFR was calculated for all pts. Pts were divided as follows: Group A= MCS GFR 30-40 (n=7), Group B= MCS GFR 41-50 (n=9), Group C= MCS GFR 51-60 (n=12), Group AA= No MCS GFR 30-40 (n=32), Group BB= No MCS GFR 41-50 (n=50), Group CC= No MCS GFR 51-60 (n=40). 6-month outcome for renal function was assessed.
Results: There was no significant difference in all three GFR range groups for 1- year survival, 1-year freedom from rejection, and post-transplant need for hemodialysis. There was also no significant difference observed in 6-month mean creatinine and 6-month mean GFR.
Conclusion: MCS pts with borderline renal function do not have more renal impairment or need for hemodialysis post-transplant. The need for HKTx does not appear different from No MCS pts. Further investigation with larger numbers is warranted.
|Endpoints||Group A MCS GFR 30-40 (n=7)||Group AA No MCS GFR 30-40 (n=32)||Group B MCS GFR 41-50 (n=9)||Group BB No MCS GFR 41-50 (n=50)||Group C MCS GFR 51-60 (n=12)||Group CC No MCS GFR 51-60 (n=40)|
|1-Year Freedom from Any Treated Rejection||100.0%||92.7%||83.3%||85.0%||90.0%||95.0%|
|Freedom from Post-Transplant Dialysis||57.1%||84.4%||77.8%||80.0%||83.3%||97.5%|
|Post Tx 6-Month Mean Creatinine, Mean ± SD||1.2 ± 0.3||1.6 ± 1.2||1.2 ± 0.3||1.6 ± 1.0||1.5 ± 0.4||1.1 ± 0.3*|
|Post Tx 6-Month Mean GFR, Mean ± SD||56.0 ± 13.2||53.9 ± 25.0||55.0 ± 22.8||56.2 ± 26.2||53.8 ± 17.3||66.7 ± 18.3|
* P < 0.05 FOR Group C vs. Group CC
CITATION INFORMATION: Neyer J, Patel J, Kittleson M, Chang D, Luu M, Aintablian T, Passano E, Czer L, Esmailian F, Kobashigawa J. Heart and Kidney Transplants in Patients with Mechanical Circulatory Support: Who Needs a Kidney? Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Neyer J, Patel J, Kittleson M, Chang D, Luu M, Aintablian T, Passano E, Czer L, Esmailian F, Kobashigawa J. Heart and Kidney Transplants in Patients with Mechanical Circulatory Support: Who Needs a Kidney? [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/heart-and-kidney-transplants-in-patients-with-mechanical-circulatory-support-who-needs-a-kidney/. Accessed June 4, 2020.
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