Impact of Treatment Strategies and Hemodynamics on Kidney Function After Heart Transplantation

Abstract

<h3>Purpose</h3> Renal failure is a common finding in patients with end stage heart failure. While some patients show stable or even improved kidney function after orthotopic heart transplantation (OHT), progressive kidney dysfunction is a common, severe comorbidity after OHT. We quantified changes in kidney function after OHT and determined predictors of persistent kidney dysfunction in a uniformly phenotyped, contemporary cohort treated in our center. <h3>Methods</h3> We analysed data of consecutive OHT recipients being transplanted between 2020 and 2021. Clinical characteristics including hemodynamic data and diuretic regimen were assessed. We performed regression analyses to identify predictors of short-term renal outcome defined as a change of renal function after seven days and one month. <h3>Results</h3> The cohort consisted of 42 OHT recipients (33 men, 78%), median age 54 (IQR 8), ejection fraction of 21% (IQR 8), TAPSE 13 mm (IQR 4), cardiac index of 1.8 L/min/m² (IQR 0.3). Right heart failure was present 16 patients (38 %). 13 patients (33 %) were on mechanical circulatory support prior to OHT and 22 (52%) patients required inotropes. Median pre-operative Creatinine was 1.72 mg/dL (IQR 0.80). Creatinine increased to a maximum of 2.90 mg/dL (IQR 1.51) 10 days after OHT but stabilized on day 30 with 2.25 mg/dL (IQR 1.23). Higher baseline creatinine (p = 0.002) and higher central venous pressure on the first day after OHT (p = 0.025) were associated with more severe kidney disease one month after OHT. Furthermore, right heart failure was associated with stage II/III kidney disease one month after OHT (p = 0.037, OR 5.7, 95% CI 1.3-25.9). Other pre-operative hemodynamic parameters and diuretic drug management had no impact on renal outcome. <h3>Conclusion</h3> In our study, high baseline creatinine and high CVP on the first day after OHT were associated with a more severe decrease of renal function after OHT pointing out the importance of an optimized fluid management in OHT candidates to clear high CVP in favour of good renal outcome. Further studies are needed to determine the optimal treatment regime for this topic with high impact on severity of chronic renal failure and survival after OHT.