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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Renal Outcomes in Patients Bridged to Heart Transplant With a Left Ventricular Assist Device
Annals of Thoracic Surgery, Volume 110, No. 2, Year 2020
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Description
Background: Patients with end-stage heart failure are increasingly being bridged to heart transplant (BTT) with mechanical circulatory support; however the association between a left ventricular assist device (LVAD) BTT strategy and posttransplant renal outcomes is unclear. The aim of this study was to analyze the association of LVAD BTT with the development of posttransplant renal failure using a large national registry. Methods: We queried the 2009 to 2018 United Network for Organ Sharing registry for all adults undergoing first-time heart or heart–kidney transplantation and stratified patients by use of pretransplant durable LVAD. The primary outcome of interest was posttransplant renal failure, which was evaluated with multivariable logistic regression. Results: Of 18,307 patients meeting inclusion criteria, 7887 were (43%) and 10,420 were not (57%) BTT with an LVAD. BTT patients had slightly better baseline renal function (estimated glomerular filtration rate, 68.7 vs 65.8 mL/min, P < .001) and were less likely to receive a heart–kidney transplant (2.7% vs 4.8%, P < .001). On multivariable logistic regression, LVAD BTT strategy was not independently associated with posttransplant renal failure (odds ratio, 1.13; 95% confidence interval, 0.86-1.49). Similarly LVAD BTT among patients with preoperative renal dysfunction was not associated with posttransplant renal failure (adjusted odds ratio, 1.40; 95% confidence interval, 0.91-2.18). Conclusions: BTT with an LVAD does not appear to be associated with worse renal outcomes regardless of baseline renal function. Furthermore, an LVAD BTT strategy in patients with chronic kidney disease may enable clinicians to identify candidates suitable for isolated heart transplantation without increasing their risk for posttransplant renal failure. © 2020 The Society of Thoracic Surgeons
Authors & Co-Authors
Fudim, Marat
United States, Durham
Duke University Medical Center
Caliskan, Kadir C.
Netherlands, Rotterdam
Erasmus Universiteit Rotterdam
DeVore, Adam D.
United States, Durham
Duke University Medical Center
Soliman, O. I.I.
Ireland, Galway
University of Galway
Rogers, Joseph G.
United States, Durham
Duke University Medical Center
Statistics
Citations: 5
Authors: 5
Affiliations: 3
Identifiers
Doi:
10.1016/j.athoracsur.2019.11.021
ISSN:
00034975
Research Areas
Noncommunicable Diseases
Study Design
Case-Control Study