Date: Monday, June 4, 2018
Session Time: 2:30pm-4:00pm
Presentation Time: 2:30pm-2:42pm
Location: Room 4C-3
It is well known that chronic kidney disease has significant negative impact on post-transplant survival in heart transplant (HTx) recipients. Here we wanted to evaluate the impact of pre-transplant dialysis on HTx patient and ESRD-free survival. Methods: We identified 1301 HTx recipients who were more than 18 years of age and required pre-transplant dialysis from the United Network for Organ Sharing database between 1/2000-12/2015. The data was analyzed using non-competing risk Cox proportional hazards model for patient and ESRD-free survival. The adjusted models included age, gender, ethnicity, body mass index, cause of heart failure, diabetes, LVAD usage, and pre-transplant ECMO. Results: Of 1301 individuals on dialysis prior to transplant, 822 (63%) that received a HTx alone (HTA) while 479 (37%) received a simultaneous heart/kidney transplant (SHK). In this cohort, 423 died during the study period while 220 developed ESRD or received a kidney transplant. SHK recipients were older, more likely to be African-American and male. Those who received HTA were associated with lower patient survival (aHR 0.62, 95% CI 0.50-0.77) and ESRD-free survival (aHR 0.54, 95% CI 0.40-0.74).
|Model 1||0.60 (0.45-0.80)||0.63(0.51-0.78)||0.62 (0.52-0.74)|
|Model 2 (Age, Gender, Ethnicity)||0.57 (0.42-0.77)||0.63 (0.50-0.77)||0.60 (0.51-0.72)|
|Model 3 (Model 2 + Cause of Heart Failiure, Diabetes, LVAD, BMI, and Use of ECMO prior to transplant)||0.55 (0.41-0.75)||0.60 (0.48-0.75)||0.58 (0.49-0.70)|
The proportion of HTx recipients receiving both heart and kidney is increasing over time. Conclusion: Dialysis pre-HTx is a significant risk factor for poor patient survival and post-transplant ESRD. Although the rate of SHK is increasing, there is a large proportion of individuals who could benefit from SHK but are receiving HTA. Further investigation is required to optimize kidney allocation in HTx patients to improve overall survival.
CITATION INFORMATION: Akkina S., Desai A., Yoo J., Hou S., Parasuraman R. Impact of Pre-Transplant Dialysis on ESRD-Free and Patient Survival in Heart Transplant Alone and in Simultaneous Heart/Kidney Transplant Recipients: UNOS Data Analysis Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Akkina S, Desai A, Yoo J, Hou S, Parasuraman R. Impact of Pre-Transplant Dialysis on ESRD-Free and Patient Survival in Heart Transplant Alone and in Simultaneous Heart/Kidney Transplant Recipients: UNOS Data Analysis [abstract]. https://atcmeetingabstracts.com/abstract/impact-of-pre-transplant-dialysis-on-esrd-free-and-patient-survival-in-heart-transplant-alone-and-in-simultaneous-heart-kidney-transplant-recipients-unos-data-analysis/. Accessed October 25, 2020.
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