Can Pre-Transplant Renal Function Predict Short-Term and Long-Term Post-Transplant Survival?

Abstract

Impaired post-transplant renal function (PRFT) is a well-described fact for survival in heart transplants. However, the effect of pre-transplant renal function and its impact on survival is poorly studied. We seek to investigate the relationship between PRFT on post HTX survival. United Network for Organ Sharing (UNOS) registry was queried for all adult heart transplant recipients (HTR) from 1999 to 2018. Serum Creatinine levels were used as a marker for renal function. We stratified the HTR based on serum creatinine values (mg/dl) at time of transplant into five groups: Group 1: 0-1mg/dl, Group 2: 1.1-1.5mg/dl, Group 3: 1.6-2mg/dl, Group 4: 2.1-3mg/dl, and Group 5: 3-4 mg/dl. A creatinine level >4mg/dl was excluded from the analysis. Kaplan-Meier survival analysis (KM), Cox regression modelling and logistic regression were used in our analysis. 34,968 patient records were analyzed and stratified into the various groups (Table). KM survival analysis showed increased survival with lower creatinine levels (p<0.0001) (Fig). On adjusting for confounding variables including diabetes, age, gender and ethnicity it was observed that creatinine had an impact on survival (p<0.0001). Logistic regression analysis of serum creatinine levels on patient graft status in 33,216 patients demonstrated that there were 11,362 deaths in total. Adjusting for similar confounders as in our previous analysis also showed that creatinine level has an impact on graft status . PRFT has a positive impact on both short-term and long-term post-transplant survival. With many patients being predisposed to a spectrum of metabolic disorders, it is apparent that PRFT is an integral part of evaluation and prediction of survival following HTX. The patho-physiological synergy between the cardiac and renal systems evidently justifies that pre-transplant optimization of renal function leads to an increased short-term and long-term post-transplant survival.