Pre-Heart Transplant Glomerular Filtration Rate and Outcome

Abstract

Heart transplantation remains the optimal treatment for end-stage heart failure. Renal insufficiency has long been considered a significant risk factor for post-heart transplant morbidity and mortality. The International Society of Heart and Lung Transplantation has suggested glomerular filtration rate (GFR) cutoffs of <40mL/min and <30mL/min in 2006 and 2016 respectively. We sought to assess our transplant patients with respect to baseline pre-transplant GFR METHODS: Between 2010 and 2018 we assessed 534 heart transplant patients and divided them based on the GFR directly before transplant. Groups were divided into GFR<30 (n=53), GFR 30-60 (n=299) and GFR>60 (n=182). All combined heart-kidney transplantations were excluded from this study. Endpoints included 1 and 5 year survival, freedom from the development of cardiac allograft vasculopathy (CAV) (as defined by stenosis ≥ 30% by angiography), non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), any treated rejection (ATR), acute cellular rejection (ACR), antibody-mediated rejection (AMR). There is no overall significant difference between the groups in terms of 1,3 or 5 year survival, 1-year freedom from CAV, NF-MACE and all rejection. However, the GFR<30 group had a significantly lower 5-year survival than the GFR>60 group, 73.6% vs. 86.8%. GFR did not greatly improve at 1-year post-transplant for any group. Heart transplantation in patients with pre-transplant GFR <30 appears to have acceptable 1-year outcomes. However, these patients have worse long-term survival and should be considered for combined heart-kidney transplant.