Analysis of Survival Outcomes Based on Hemodialysis Requirement after Heart Transplantation

Abstract

<h3>Purpose</h3> We sought to analyze whether the requirement of hemodialysis after heart transplantation affects post-transplant outcomes of heart transplant recipients. <h3>Methods</h3> In the UNOS registry, from 1994 to 2020, we identified 50,503 heart transplant recipients who did not receive hemodialysis (HD) in their post-transplant course (NON-HD), and 5,159 who did receive HD in their post-transplant course (YES-HD). Baseline characteristics were compared with respect to age, gender, race, and baseline hemodynamics, and Kaplan-Meyer survival analysis was performed. <h3>Results</h3> There was a significantly lower survival at 30 days (79% vs. 97%), 1 year (55% vs. 92%), 5 years (43% vs. 78%), and 10 years (31% vs. 60%) in the YES-HD compared to the NON-HD group (log rank, p<0.001, Figure). Additionally, use of mechanical circulatory support including IABP (9.8% vs 6.3%, p<0.001) and VAD (38.2% vs 29.2%, p<0.001) as well as ventilator support (8.6% vs 3.7%, p<0.001) at time of transplantation were increased in the YES-HD cohort. A greater proportion of patients in the YES-HD compared to the NON-HD group had a median ischemic time greater than 4 hours (26.9% vs 20.1%, p<0.001). Patients in the YES-HD group were older (49 years old vs 46 years old, p<0.001) and more patients were male (75.5% vs 72.4%, p<0.001). <h3>Conclusion</h3> Heart transplant recipients requiring dialysis at discharge (YES-HD) have significantly increased mortality compared to the NON-HD group. This population is associated with markers of increased acuity. Further investigation is required to assess the factors contributing to poorer outcomes in patients requiring dialysis after transplantation, including how to mitigate this and when to consider multi-organ transplantation.