Clinical trends, risk factors, and temporal effects of post-transplant dialysis on outcomes following orthotopic heart transplantation in the 2018 United States heart allocation system.

Autor:	Hong Y; Department of Surgery, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania., Hess NR; Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania., Ziegler LA; Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania., Hickey GW; Division of Cardiology, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania., Huston JH; Division of Cardiology, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania., Mathier MA; Division of Cardiology, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania., McNamara DM; Division of Cardiology, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania., Keebler ME; Division of Cardiology, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania., Kaczorowski DJ; Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: kaczorowskidj2@upmc.edu.
Jazyk:	angličtina
Zdroj:	The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2023 Jun; Vol. 42 (6), pp. 795-806. Date of Electronic Publication: 2023 Jan 20.
DOI:	10.1016/j.healun.2023.01.004
Abstrakt:	Background: This study evaluated the current clinical trends, risk factors, and temporal effects of post-transplant dialysis on outcomes following orthotopic heart transplantation after the 2018 United States adult heart allocation policy change. Methods: The United Network for Organ Sharing (UNOS) registry was queried to analyze adult orthotopic heart transplant recipients after the October 18, 2018 heart allocation policy change. The cohort was stratified according to the need for post-transplant de novo dialysis. The primary outcome was survival. Propensity score-matching was performed to compare the outcomes between 2 similar cohorts with and without post-transplant de novo dialysis. The impact of post-transplant dialysis chronicity was evaluated. Multivariable logistic regression was performed to identify risk factors for post-transplant dialysis. Results: A total of 7,223 patients were included in this study. Out of these, 968 patients (13.4%) developed post-transplant renal failure requiring de novo dialysis. Both 1-year (73.2% vs 94.8%) and 2-year (66.3% vs 90.6%) survival rates were lower in the dialysis cohort (p < 0.001), and the lower survival rates persisted in a propensity-matched comparison. Recipients requiring only temporary post-transplant dialysis had significantly improved 1-year (92.5% vs 71.6%) and 2-year (86.6 % vs 52.2%) survival rates compared to the chronic post-transplant dialysis group (p < 0.001). Multivariable analysis demonstrated low pretransplant estimated glomerular filtration (eGFR) and bridge with extracorporeal membrane oxygenation (ECMO) were strong predictors of post-transplant dialysis. Conclusions: This study demonstrates that post-transplant dialysis is associated with significantly increased morbidity and mortality in the new allocation system. Post-transplant survival is affected by the chronicity of post-transplant dialysis. Low pretransplant eGFR and ECMO are strong risk factors for post-transplant dialysis. Competing Interests: Disclosure statement Dr. Kaczorowski received consultant and speaking fees for Medtronic and Abiomed. There are no direct conflicts of interest as it relates to this manuscript. (Copyright © 2023 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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