Predictors of Renal Graft Failure in Heart/Kidney Transplant Recipients

Abstract

Combined heart and kidney transplantation have a protective effect on the cardiac graft. Little is known about the factors that impact renal graft function post-transplant. We set out to assess the impact of donor, recipient and transplant characteristics on post-transplant renal graft function. We evaluated combined heart-kidney transplant recipients at a single center from March 2012 to December 2017. Recipients with primary cardiac graft dysfunction were excluded. The primary outcome was delayed renal graft function (DRGF) as defined by need for dialysis within the first week of transplantation. The secondary outcome was any dialysis requirement within the first year. A univariate logistic regression model was used to assess the association between the donor, recipient and transplant factors with the primary and secondary outcomes. We identified 66 combined heart-kidney transplant recipients for analysis. Elevated recipient creatinine prior to transplant was associated with DRGF (OR 1.80, 95% 1.25-2.59, p = 0.002). Other evaluated donor and recipient factors were otherwise not associated with acute renal dysfunction (Table 1). Elevated pre-transplant creatinine (OR 1.73, 95% 1.21-2.50, p = 0.003) and redo transplantation (OR 5.70, 95% 1.05-30.87, p = 0.043) were associated with needing dialysis within the first year after transplant (Table 2). In our single center experience of combined heart and kidney transplantation, recipient creatinine prior to transplant was the biggest predictor of primary renal graft failure. In addition, redo heart transplantation increases risk of dialysis within the first year.