Risk of Renal Dysfunction Following Heart Transplantation in Patients Bridged with Left Ventricular Assist Devices

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Abstract

PURPOSE: Acute kidney injury (AKI) and chronic kidney disease (CKD) cause morbidity and mortality following heart transplantation (HT). Left ventricular assist devices (LVAD) are often used as a bridge to HT. We sought to determine the incidence and risk factors for developing AKI and CKD following HT in LVAD patients. METHODS: We examined the ISHLT Transplant Registry for heart alone transplant patients between 2000-15. We compared patients bridged with durable continuous-flow LVAD to those without LVAD bridging. Primary outcomes were AKI (defined as post-HT dialysis prior to discharge) and CKD (defined as creatinine >2.5 mg/dL, chronic dialysis, or renal transplant) within 3 years. Chi-squared and Gray's tests compared incidence rates while accounting for competing risk of death. Multivariable logistic and Cox regression analyses were used. RESULTS: There were 21,432 total patients, with 5,038 having LVAD support. LVAD patients had a higher incidence of AKI and CKD at 1 year, but a similar incidence of CKD at 3 years (Table). Multivariable regression analysis showed that non-LVAD patients had OR 0.74 (95% CI 0.63-0.86; p=0.0001) for AKI at discharge and HR 0.90 (95% CI 0.80-1.01; p=0.0635) for CKD at 3 years. Among LVAD patients, certain characteristics were significantly associated with development of AKI and CKD (Fig). CONCLUSION: LVAD patients had higher incidence of AKI at hospital discharge and CKD at 1 year after HT compared to patients without LVAD bridging, but development of CKD was similar by 3 years. Baseline renal function, BMI, ischemic time, and diabetes can identify LVAD patients at risk for post-HT AKI or CKD.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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