Evidence supports severe renal insufficiency as a relative contraindication to heart transplantation

Kimberly N. Hong, Aurelie Merlo, Dhaval Chauhan, Ryan R Davies, Alexander Iribarne, Elizabeth Johnson, Val Jeevanandam, Mark J. Russo

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background This study was conducted to determine whether survival after orthotopic heart transplant (OHT) is associated with pre-transplant estimated glomerular filtration rate (eGFR) and to define ranges of pre-OHT eGFR associated with differences in post-transplant survival. The 2006 International Society for Heart and Lung Transplantation revised listing criteria for OHT stated that chronic kidney disease, defined by an eGFR <40 ml/min is a relative contraindication for OHT alone. The committee noted that this recommendation was supported by consensus opinion of experts and not data derived from a randomized trial or non-randomized studies. Methods The United Network for Organ Sharing provided deidentified patient-level data. The study population included 17,459 OHT recipients aged ≥18 years who received allografts between January 1, 2001, and December 31, 2009. Logistic regression was used to assess the effect of multiple variables on survival after OHT. Receiver operating characteristic curves and stratum-specific likelihood ratios were generated to compare 1-year survival at eGFR thresholds. The primary outcomes measure was actuarial post-transplant survival expressed in years. Results Regression analysis showed that a lower pre-transplant eGFR is associated with worse post-transplant survival. Threshold analysis demonstrated 3 distinct survival strata: eGFR ≤ 34 ml/min, eGFR 35 to 49 ml/min, and eGFR > 49 ml/min. Graft survival at all times is decreased for patients with eGFR ≤ 34 ml/min. They are also more likely to have in-hospital and long-term complications. Conclusions eGFR is a strong predictor of post-transplant survival and should be considered when assessing patients for OHT. This analysis supports current International Society for Heart and Lung Transplantation guidelines and suggests that end-stage heart failure patients with an eGFR ≤ 34 ml/min is a relative contraindication for heart transplantation alone.

Original languageEnglish (US)
Pages (from-to)893-900
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume35
Issue number7
DOIs
StatePublished - Jul 1 2016

Fingerprint

Heart Transplantation
Renal Insufficiency
Glomerular Filtration Rate
Transplants
Graft Survival
Chronic Renal Insufficiency
Heart Failure
Guidelines
Survival

Keywords

  • chronic kidney disease
  • estimated glomerular filtration rate
  • mortality
  • orthotopic heart transplant
  • outcomes
  • renal insufficiency

ASJC Scopus subject areas

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

Cite this

Evidence supports severe renal insufficiency as a relative contraindication to heart transplantation. / Hong, Kimberly N.; Merlo, Aurelie; Chauhan, Dhaval; Davies, Ryan R; Iribarne, Alexander; Johnson, Elizabeth; Jeevanandam, Val; Russo, Mark J.

In: Journal of Heart and Lung Transplantation, Vol. 35, No. 7, 01.07.2016, p. 893-900.

Research output: Contribution to journalArticle

Hong, Kimberly N. ; Merlo, Aurelie ; Chauhan, Dhaval ; Davies, Ryan R ; Iribarne, Alexander ; Johnson, Elizabeth ; Jeevanandam, Val ; Russo, Mark J. / Evidence supports severe renal insufficiency as a relative contraindication to heart transplantation. In: Journal of Heart and Lung Transplantation. 2016 ; Vol. 35, No. 7. pp. 893-900.
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abstract = "Background This study was conducted to determine whether survival after orthotopic heart transplant (OHT) is associated with pre-transplant estimated glomerular filtration rate (eGFR) and to define ranges of pre-OHT eGFR associated with differences in post-transplant survival. The 2006 International Society for Heart and Lung Transplantation revised listing criteria for OHT stated that chronic kidney disease, defined by an eGFR <40 ml/min is a relative contraindication for OHT alone. The committee noted that this recommendation was supported by consensus opinion of experts and not data derived from a randomized trial or non-randomized studies. Methods The United Network for Organ Sharing provided deidentified patient-level data. The study population included 17,459 OHT recipients aged ≥18 years who received allografts between January 1, 2001, and December 31, 2009. Logistic regression was used to assess the effect of multiple variables on survival after OHT. Receiver operating characteristic curves and stratum-specific likelihood ratios were generated to compare 1-year survival at eGFR thresholds. The primary outcomes measure was actuarial post-transplant survival expressed in years. Results Regression analysis showed that a lower pre-transplant eGFR is associated with worse post-transplant survival. Threshold analysis demonstrated 3 distinct survival strata: eGFR ≤ 34 ml/min, eGFR 35 to 49 ml/min, and eGFR > 49 ml/min. Graft survival at all times is decreased for patients with eGFR ≤ 34 ml/min. They are also more likely to have in-hospital and long-term complications. Conclusions eGFR is a strong predictor of post-transplant survival and should be considered when assessing patients for OHT. This analysis supports current International Society for Heart and Lung Transplantation guidelines and suggests that end-stage heart failure patients with an eGFR ≤ 34 ml/min is a relative contraindication for heart transplantation alone.",
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AU - Hong, Kimberly N.

AU - Merlo, Aurelie

AU - Chauhan, Dhaval

AU - Davies, Ryan R

AU - Iribarne, Alexander

AU - Johnson, Elizabeth

AU - Jeevanandam, Val

AU - Russo, Mark J.

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N2 - Background This study was conducted to determine whether survival after orthotopic heart transplant (OHT) is associated with pre-transplant estimated glomerular filtration rate (eGFR) and to define ranges of pre-OHT eGFR associated with differences in post-transplant survival. The 2006 International Society for Heart and Lung Transplantation revised listing criteria for OHT stated that chronic kidney disease, defined by an eGFR <40 ml/min is a relative contraindication for OHT alone. The committee noted that this recommendation was supported by consensus opinion of experts and not data derived from a randomized trial or non-randomized studies. Methods The United Network for Organ Sharing provided deidentified patient-level data. The study population included 17,459 OHT recipients aged ≥18 years who received allografts between January 1, 2001, and December 31, 2009. Logistic regression was used to assess the effect of multiple variables on survival after OHT. Receiver operating characteristic curves and stratum-specific likelihood ratios were generated to compare 1-year survival at eGFR thresholds. The primary outcomes measure was actuarial post-transplant survival expressed in years. Results Regression analysis showed that a lower pre-transplant eGFR is associated with worse post-transplant survival. Threshold analysis demonstrated 3 distinct survival strata: eGFR ≤ 34 ml/min, eGFR 35 to 49 ml/min, and eGFR > 49 ml/min. Graft survival at all times is decreased for patients with eGFR ≤ 34 ml/min. They are also more likely to have in-hospital and long-term complications. Conclusions eGFR is a strong predictor of post-transplant survival and should be considered when assessing patients for OHT. This analysis supports current International Society for Heart and Lung Transplantation guidelines and suggests that end-stage heart failure patients with an eGFR ≤ 34 ml/min is a relative contraindication for heart transplantation alone.

AB - Background This study was conducted to determine whether survival after orthotopic heart transplant (OHT) is associated with pre-transplant estimated glomerular filtration rate (eGFR) and to define ranges of pre-OHT eGFR associated with differences in post-transplant survival. The 2006 International Society for Heart and Lung Transplantation revised listing criteria for OHT stated that chronic kidney disease, defined by an eGFR <40 ml/min is a relative contraindication for OHT alone. The committee noted that this recommendation was supported by consensus opinion of experts and not data derived from a randomized trial or non-randomized studies. Methods The United Network for Organ Sharing provided deidentified patient-level data. The study population included 17,459 OHT recipients aged ≥18 years who received allografts between January 1, 2001, and December 31, 2009. Logistic regression was used to assess the effect of multiple variables on survival after OHT. Receiver operating characteristic curves and stratum-specific likelihood ratios were generated to compare 1-year survival at eGFR thresholds. The primary outcomes measure was actuarial post-transplant survival expressed in years. Results Regression analysis showed that a lower pre-transplant eGFR is associated with worse post-transplant survival. Threshold analysis demonstrated 3 distinct survival strata: eGFR ≤ 34 ml/min, eGFR 35 to 49 ml/min, and eGFR > 49 ml/min. Graft survival at all times is decreased for patients with eGFR ≤ 34 ml/min. They are also more likely to have in-hospital and long-term complications. Conclusions eGFR is a strong predictor of post-transplant survival and should be considered when assessing patients for OHT. This analysis supports current International Society for Heart and Lung Transplantation guidelines and suggests that end-stage heart failure patients with an eGFR ≤ 34 ml/min is a relative contraindication for heart transplantation alone.

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KW - outcomes

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