Severely Reduced Kidney Function Assessed by a Single eGFR Determination at the Time of an Isolated Heart Transplant Does Not Predict Inevitable Posttransplant ESKD. Issue 4 (14th October 2022)

• Record Type: Journal Article
• Authors: Kumar, Abhishek; Bonnell, Levi N.; Thomas, Christie P.
• Is Part Of: Transplantation. Volume 107:Issue 4(2023)
• Page Start: 981
• Page End: 987
• Publication Date: 2022-10-14
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000004350
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: Consensus guidelines advise simultaneous heart kidney transplantation (SHK) in heart candidates with an estimated glomerular filtration rate (eGFR) of <30 mL/min/1.73 m 2 . We hypothesize that a significant fraction of such patients would not need an SHK, even though a graded increase in mortality and end-stage kidney disease (ESKD) would be seen with decrements in eGFR. Methods: United Network of Organ Sharing data for isolated heart transplants between 2000 and 2020 were divided into two groups based on eGFR at transplant (≤20 mL/min/1.73 m 2 and 21–29 mL/min/1.73 m 2 ). The primary outcome was mortality and secondary outcome was ESKD posttransplant. Cox regression and cumulative incidence competing risk methods were used to compare risk of mortality and ESKD. Results: There was no difference in mortality (adjusted hazard ratio [aHR] 0.82 [95% confidence interval, CI: 0.60-1.11, P = 0.21]) or ESKD (aHR 1.01 [95% CI: 0.49-2.09, P = 0.96]) between the two groups (≤20 versus 21–29). The overall incidence of ESKD for the entire cohort at 1, 5, and 10 y were 1.5%, 9.5%, and 20%. Conclusions: Although risk of ESKD is highest in heart candidates with an eGFR <30 mL/min/1.73 m 2, <10% of patients reach ESKD within 5 y‚ and most will recover significant renal function posttransplant. More refined selection criteria are required to identify candidates for SHK.