Dialysis prior to heart transplant (HTx) is a strong predictor of patient death and is a common indication for simultaneous heart/kidney transplantation (SHK). The association of pre-transplant (pre-Tx) non-dialysis dependent renal dysfunction on post-transplant ESRD is not well defined. In this study, we looked at the association between dialysis-free survival and patient survival with pre-Tx CKD. Methods: We identified 28,774 HTx alone recipients over the age of 18 from the United Network of Organ Sharing database between 1/2000 and 12/2015 that did not require dialysis pre-Tx. The primary outcomes were ESRD-free survival, patient survival, and the combined endpoint of ESRD-free and patient survival. The data were analyzed using a non-competing risk Cox proportional hazards model. The adjusted models included age, gender, ethnicity, cause of heart failure, diabetes, use of a VAD, being status 1A at the time of listing, use of an intra-aortic balloon pump prior to transplant, use of calcineurin inhibitor, mTOR inhibitor, lymphocyte depleting agent, or IL-2 receptor antibodies. Results: Of the 28,774 heart transplant alone recipients, 6,542 (23%) had stage 3A CKD (GFR 45-60mL/min/1.73m2), 3,669 (13%) had stage 3B CKD (30-45mL/min/1.73m2), 740 (3%) with stage 4 CKD (GFR 15-30mL/min/1.73m2), and 462 (2%) had stage 5 CKD (GFR < 15mL/min/1.73m2) at the time of transplant. Within this cohort, 2105 (7%) developed ESRD or received a kidney transplant while 8,093 (28%) died during the study period. The stage 5 CKD group was notably younger, non-diabetic, and had a lower BMI compared to the other CKD groups. In addition, stage 5 CKD was less likely to have a VAD and more likely to use mTOR inhibitors. The adjusted analyses are shown below.

Conclusion: Lower renal function pre-Tx is associated with a higher risk of ESRD/transplant and death compared to normal renal function pre-Tx. Further study is needed to determine if SHK can improve outcomes for those with pre-Tx non-dialysis dependent renal dysfunction.

CITATION INFORMATION: Akkina S., Desai A., Yoo J., Hou S., Parasuraman R. Impact of Pre-Transplant Non-Dialysis Renal Dysfunction in Heart Transplant Recipients on Post-Transplant ESRD: A UNOS Database Analysis Am J Transplant. 2017;17 (suppl 3).

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