Session Name: Kidney: Cardiovascular and Metabolic Complications
Session Date & Time: None. Available on demand.
*Purpose: Cardiovascular disease is the main cause of mortality after kidney transplantation. Many patients with ESRD have heart failure that is attributed to fluid overload. The Seattle heart failure model (Seattle Model) is a risk model based on clinical status, therapy and laboratory parameters. It includes the following variables: age, gender, NYHA class, ejection fraction (EF), ischemic disease, systolic BP, use of angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, statin, betablocker, diuretics, allopurinol, sodium, hemoglobin, lymphocytes, uric acid, and cholesterol. It predicts survival in patients with heart failure. Our objective was to apply this model to patients with ESRD at the time of their evaluation for kidney transplant and to determine whether the model predicts mortality after transplant.
*Methods: This is a retrospective study of all adult, deceased donor kidney transplants from 2014 to 2017. We used univariate and multivariate logistic regression models (p <0.05).
*Results: A total of 154 kidney transplant patients were reviewed. The table shows the patient characteristics and outcomes. The overall mortality was 9.7%. The one-year survival from the Seattle Model predicted all-cause mortality after transplant in patients with an EF ≤50% or the presence of ventricular hypertrophy (p=0.045, OR 0.70), this after controlling for age and gender. All input factors of the model where evaluated individually in univariate analysis and none of the factors alone was a significant predictor of mortality.
*Conclusions: The Seattle Model is a useful tool to predict mortality in patients with heart failure and it does not take into account kidney function. We show for the first time that this model can be used in patients with ESRD and cardiac impairment and can help to better select patients for transplant. It can also identify those patients that need cardiac rehabilitation or treatment optimization to reduce risk of death after transplant.
|Age||52 (20 – 79)|
|BMI (median)||27.5 (18.2 – 46.1)|
|Years on dialysis||6.7 (0.7 – 17.5)|
|Delayed graft function||45.6%|
To cite this abstract in AMA style:Perez-Gutierrez A, Bachul PJ, Danz DN, Juengel B, Josephson M, Fung J, Witkowski P, Chung B, Becker Y. The Seattle Heart Failure Model is a Predictor of Mortality After Kidney Transplant in Patients with End Stage Renal Disease and Heart Impairment [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/the-seattle-heart-failure-model-is-a-predictor-of-mortality-after-kidney-transplant-in-patients-with-end-stage-renal-disease-and-heart-impairment/. Accessed September 16, 2021.
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