Risk of Renal Dysfunction Following Heart Transplantation in Patients Bridged with Left Ventricular Assist Devices

Abstract

Acute kidney injury (AKI) and chronic kidney disease (CKD) cause morbidity and mortality following heart transplantation (HT). Left ventricular assist devices (LVAD) are often used as a bridge to HT. We sought to determine the incidence and risk factors for developing AKI and CKD following HT in LVAD patients. We examined the ISHLT Transplant Registry for heart alone transplant patients between 2000-15. We compared patients bridged with durable continuous-flow LVAD to those without LVAD bridging. Primary outcomes were AKI (defined as post-HT dialysis prior to discharge) and CKD (defined as creatinine >2.5 mg/dL, chronic dialysis, or renal transplant) within 3 years. Chi-squared and Gray's tests compared incidence rates while accounting for competing risk of death. Multivariable logistic and Cox regression analyses were used. There were 21,432 total patients, with 5,038 having LVAD support. LVAD patients had a higher incidence of AKI and CKD at 1 year, but a similar incidence of CKD at 3 years (Table). Multivariable regression analysis showed that non-LVAD patients had OR 0.74 (95% CI 0.63-0.86; p=0.0001) for AKI at discharge and HR 0.90 (95% CI 0.80-1.01; p=0.0635) for CKD at 3 years. Among LVAD patients, certain characteristics were significantly associated with development of AKI and CKD (Fig). LVAD patients had higher incidence of AKI at hospital discharge and CKD at 1 year after HT compared to patients without LVAD bridging, but development of CKD was similar by 3 years. Baseline renal function, BMI, ischemic time, and diabetes can identify LVAD patients at risk for post-HT AKI or CKD.