Trends, predictors and outcomes of need for hemodialysis after heart transplantation

Abstract

Abstract Introduction Acute renal failure is not uncommon immediately after heart transplantation (HT) and it is related to pre-existing cardiorenal syndrome, perioperative parameters, early post-operative course and initiation of calcineurin inhibitor therapy. We sought to investigate the trends, predictors and outcomes of renal failure requiring hemodialysis after HT. Methods Adult HT recipients were identified in the United Network for Organ Sharing (UNOS) registry between 2009 and 2020. Patients were grouped according to the requirement for hemodialysis in the post-operative period after HT. Accounting for re-transplantation, Fine and Gray's test compared cumulative incidences of all-cause mortality between groups. Univariate and multivariate analysis were performed using the competing risk model. Results A total of 26,634 patients were included in the study including 3,148 HT that required hemodialysis. Overall, the incidence of post HT dialysis increased during the study period (p<0.001, Figure 1). Patients on hemodialysis had significantly higher serum creatinine at the time of HT (1.51 vs. 1.21 mg/dl, p<0.001). Multivariable logistic regression analysis identified longer ischemic time (p<0.001), serum creatinine at HT higher than 1.2 mg/dl, higher calculated panel reactive antibody (%) (p=0.003), prior cardiac surgery (p<0.001), older donor age (p<0.001), higher recipient body mass index (p<0.001), mechanical ventilation at HT (p<0.001), support with extracorporeal membrane oxygenation (p<0.001) as independent predictors of hemodialysis need after HT. After adjusting for described confounders patients on hemodialysis had higher risk of 30-day (odds ratio 1.44, 95% CI 1.33–1.56, p<0.001) and all-cause mortality (sub-hazard ratio = 5.4, 95% CI 4.81–6.03, p<0.001) Conclusion Over 1 in 10 HT recipients require hemodialysis after HT. Need for hemodialysis is associated with worse 30-day and long-term mortality after HT. Funding Acknowledgement Type of funding sources: None. Figure 1