Progression Trajectories of Glomerular Filtration Rate Are Associated with Heart Transplantation Outcomes

Abstract

<h3>Purpose</h3> The patterns of kidney function deterioration after heart transplantation (HT) are diverse; some patients have non-progressive or slowly progressive kidney disease while other progress rapidly to end-stage renal disease (ESRD). Little is known about the impact of renal function decline pattern, rather than the development of renal dysfunction per se, on HT outcomes. We aimed to test the hypotheses that progression trajectories of estimated glomerular filtration rate (eGFR) would be associated with varying risks of HT outcomes. <h3>Methods</h3> We used the latent class linear mixed model to identify patients with similar trajectories of eGFR deterioration after HT. Each pattern was served as the exposure variable. Outcomes included mortality, ESRD, and cardiac allograft vasculopathy (CAV). <h3>Results</h3> Using a median of 122 [91,206] serum creatinine measurements per patient, during 9 [6,14] years of follow up, a total of 166 patients were grouped into six distinct eGFR trajectories (Fig. 1A). We found an association between the distinct profiles of eGFR trajectories and HT outcomes. eGFR trajectories 4 and 6 were associated with higher post-transplant mortality rates (5-year mortality 18% [95% CI, 0-35] and 57% [95% CI, 23-79], respectively), in comparison with trajectories 1 and 2 that were characterized by 5-year survival of 100% (log-rank <i>P</i><0.0001; Fig. 1B). Similarly, Kaplan-Meier survival analysis showed that, at 5 years after HT, ESRD rate was 100% for group 6, 18% for group 5, and 36 % for group 4, in comparison with 0% for groups 1-3 (log-rank <i>P</i><0.0001; Fig. 1C). Rate of CAV at 5-year was significantly higher for trajectories 2,5 and 6 (34%, 20% and 47%) in comparison with groups 1,3,4 (0%, 8%, 12%), respectively (log-rank <i>P</i>=0.038; Fig. 1D). <h3>Conclusion</h3> Understanding the progression trajectory of eGFR following HT can guide clinical decision-making. Transition to a calcineurin inhibitors-free regimen, as a disease-modifying intervention, should be considered for patients with trajectories 4-6.