Rethinking the Impact of Donor eGFR on Heart Transplant Outcomes

Abstract

<h3>Purpose</h3> With limited evidence regarding the effect of donor renal function on outcomes post-cardiac transplant, this study sought to determine if donor eGFR has an impact on post-transplant outcomes in patients undergoing heart transplantation. <h3>Methods</h3> The UNOS Registry was queried for all cardiac transplant recipients and stratified into two groups by donor eGFR: eGFR >60 (high) or eGFR <60 (low). Baseline characteristics were compared via standard statistical analysis. Survival analysis was censored at 5-years using Kaplan-Meier analysis, and Cox proportional regression analysis was adjusted for age, sex, diabetes, race, ischemic time, dialysis, life support, waiting time, and HLA mismatch. <h3>Results</h3> 37205 subjects were grouped to high eGFR and 14892 subjects to low eGFR. Donors with low eGFR were more likely to be older (31.3 vs 32.9, p< 0.001). Recipients were more likely to be older (54.7 years vs 52.4, p<0.001) and male (77.2% vs 74.3% p<0.001). Compared to the high eGFR group, heart transplant recipients from donors in the low eGFR group showed no significant difference in mortality (p= 0.30) or causes of death (p= 0.054). Unadjusted analysis showed a hazard ratio of 0.978 (0.938-1.019 95% CI). Following adjustment, HR was 0.992 (0.948-1.039 95% CI). <h3>Conclusion</h3> Our study presents preliminary data to demonstrate cardiac donors with low eGFR have similar outcomes and life expectancy up to 60 months as compared to donors with high eGFR. With further research, there is an opportunity to expand the eligibility requirements for donor heart procurement and thereby increase the potential donor pool.