Outcomes in Patients With LVADs Undergoing Simultaneous Heart-Kidney Transplantation

JESSICA Atkins; NICHOLAS R. HESS; SHENG FU; JACOB M. READ; JENNIFER M. HAJJ; BHAVADHARINI RAMU; DANIEL N. SILVERMAN; CHAKRADHARI INAMPUDI; ADRIAN B. VANBAKEL; Z. A. HASHMI; NICHOLAS H. POPE; LUCAS P. WITER; MANREET K. KANWAR; ANDREW J. SAUER; BRIAN A. HOUSTON; ARMAN KILIC; RYAN J. TEDFORD

doi:10.1016/j.cardfail.2022.04.016

Outcomes in Patients With LVADs Undergoing Simultaneous Heart-Kidney Transplantation

JESSICA Atkins, NICHOLAS R. HESS, SHENG FU, JACOB M. READ, JENNIFER M. HAJJ, BHAVADHARINI RAMU, DANIEL N. SILVERMAN, CHAKRADHARI INAMPUDI, ADRIAN B. VANBAKEL, Z. A. HASHMI, NICHOLAS H. POPE, LUCAS P. WITER, MANREET K. KANWAR, ANDREW J. SAUER, BRIAN A. HOUSTON, ARMAN KILIC, RYAN J. TEDFORD

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

Background: Multiple studies have shown better outcomes for simultaneous heart-kidney transplant (sHKT) than for isolated orthotopic heart transplant (iOHT) in recipients with chronic kidney disease (CKD). However, outcomes in patients supported by durable left ventricular assist devices (LVADs) have not been well studied. Methods: Patients with durable LVADs and stage 3 or higher CKD (eGFR < 60 mL/min/1.73 m²) undergoing iOHT or sHKT between 2008 and 2020 were identified from the United Network for Organ Sharing registry. A Kaplan-Meier survival analysis with associated log-rank test was conducted to compare post-transplant survival rates. Multivariable modeling was used to identify risk-adjusted predictors of 1 year post-transplant mortality. Results: We identified 4375 patients; 366 underwent sHKT, and 4009 underwent iOHT. The frequency of sHKT increased during the study period. The 1-year post-transplant survival rate was worse in patients after sHKT than in patients after iOHT (80.3% vs 88.3%; P < 0.001) and persisted up to 5 years post-transplant (P = 0.001). sHKT recipients were more likely to require dialysis after transplantation and had longer hospital lengths of stay (P < 0.001). Multivariable analysis showed that sHKT remained an independent risk factor for mortality at 1 year (OR 1.58; P = 0.002). Conclusions: sHKT is becoming more common in patients with durable LVADs. Compared with iOHT, patients with sHKTs have worse short- and long-term survival rates and are more likely to require post-transplant dialysis.

Original language	English (US)
Pages (from-to)	1584-1592
Number of pages	9
Journal	Journal of cardiac failure
Volume	28
Issue number	11
DOIs	https://doi.org/10.1016/j.cardfail.2022.04.016
State	Published - Nov 2022
Externally published	Yes

Bibliographical note

Funding Information:
None. No grants, contracts or other financial support were received for this manuscript. CI reports a consulting relationship with Abbott; ABVB reports DSMB committee work for TransMedics and research support from CareDx; AJS reports a consulting relationship with Medtronic, Abbott, Boston Scientific, and Edwards Life Sciences and is on steering committees with Medtronic, Abbott and Boston Scientific; BAH reports consulting relationships with Medtronic and Bioventrix and has received research grant funding from Medtronic; AK reports a consulting relationship with Abiomed and being on the medical advisor board for Medtronic; RJT reports consulting relationships with Medtronic, Abbott, Aria CV, Arena Pharmaceuticals, Acceleron, Itamar, Edwards LifeSciences, Eidos Therapeutics, Lexicon Pharmaceuticals, Gradient, and United Therapeutics and is on steering committees for Medtronic, Acceleron and Abbott, is on a research advisory board for Abiomed and does hemodynamic core lab work for Actelion and Merck. All other listed authors have no disclosures to report.

Publisher Copyright:
© 2022 Elsevier Inc.

Keywords

chronic kidney disease
heart-kidney transplant
Left ventricular assist device
orthotopic heart transplant

PubMed: MeSH publication types

Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.cardfail.2022.04.016

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Atkins, JESSICA., HESS, NICHOLAS. R., FU, SHENG., READ, JACOB. M., HAJJ, JENNIFER. M., RAMU, BHAVADHARINI., SILVERMAN, DANIEL. N., INAMPUDI, CHAKRADHARI., VANBAKEL, ADRIAN. B., HASHMI, Z. A., POPE, NICHOLAS. H., WITER, LUCAS. P., KANWAR, MANREET. K., SAUER, ANDREW. J., HOUSTON, BRIAN. A., KILIC, ARMAN., & TEDFORD, RYAN. J. (2022). Outcomes in Patients With LVADs Undergoing Simultaneous Heart-Kidney Transplantation. Journal of cardiac failure, 28(11), 1584-1592. https://doi.org/10.1016/j.cardfail.2022.04.016

Atkins, JESSICA, HESS, NICHOLASR, FU, SHENG, READ, JACOBM, HAJJ, JENNIFERM, RAMU, BHAVADHARINI, SILVERMAN, DANIELN, INAMPUDI, CHAKRADHARI, VANBAKEL, ADRIANB, HASHMI, ZA, POPE, NICHOLASH, WITER, LUCASP, KANWAR, MANREETK, SAUER, ANDREWJ, HOUSTON, BRIANA, KILIC, ARMAN & TEDFORD, RYANJ 2022, 'Outcomes in Patients With LVADs Undergoing Simultaneous Heart-Kidney Transplantation', Journal of cardiac failure, vol. 28, no. 11, pp. 1584-1592. https://doi.org/10.1016/j.cardfail.2022.04.016

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title = "Outcomes in Patients With LVADs Undergoing Simultaneous Heart-Kidney Transplantation",

abstract = "Background: Multiple studies have shown better outcomes for simultaneous heart-kidney transplant (sHKT) than for isolated orthotopic heart transplant (iOHT) in recipients with chronic kidney disease (CKD). However, outcomes in patients supported by durable left ventricular assist devices (LVADs) have not been well studied. Methods: Patients with durable LVADs and stage 3 or higher CKD (eGFR < 60 mL/min/1.73 m2) undergoing iOHT or sHKT between 2008 and 2020 were identified from the United Network for Organ Sharing registry. A Kaplan-Meier survival analysis with associated log-rank test was conducted to compare post-transplant survival rates. Multivariable modeling was used to identify risk-adjusted predictors of 1 year post-transplant mortality. Results: We identified 4375 patients; 366 underwent sHKT, and 4009 underwent iOHT. The frequency of sHKT increased during the study period. The 1-year post-transplant survival rate was worse in patients after sHKT than in patients after iOHT (80.3% vs 88.3%; P < 0.001) and persisted up to 5 years post-transplant (P = 0.001). sHKT recipients were more likely to require dialysis after transplantation and had longer hospital lengths of stay (P < 0.001). Multivariable analysis showed that sHKT remained an independent risk factor for mortality at 1 year (OR 1.58; P = 0.002). Conclusions: sHKT is becoming more common in patients with durable LVADs. Compared with iOHT, patients with sHKTs have worse short- and long-term survival rates and are more likely to require post-transplant dialysis.",

keywords = "chronic kidney disease, heart-kidney transplant, Left ventricular assist device, orthotopic heart transplant",

author = "JESSICA Atkins and HESS, {NICHOLAS R.} and SHENG FU and READ, {JACOB M.} and HAJJ, {JENNIFER M.} and BHAVADHARINI RAMU and SILVERMAN, {DANIEL N.} and CHAKRADHARI INAMPUDI and VANBAKEL, {ADRIAN B.} and HASHMI, {Z. A.} and POPE, {NICHOLAS H.} and WITER, {LUCAS P.} and KANWAR, {MANREET K.} and SAUER, {ANDREW J.} and HOUSTON, {BRIAN A.} and ARMAN KILIC and TEDFORD, {RYAN J.}",

note = "Funding Information: None. No grants, contracts or other financial support were received for this manuscript. CI reports a consulting relationship with Abbott; ABVB reports DSMB committee work for TransMedics and research support from CareDx; AJS reports a consulting relationship with Medtronic, Abbott, Boston Scientific, and Edwards Life Sciences and is on steering committees with Medtronic, Abbott and Boston Scientific; BAH reports consulting relationships with Medtronic and Bioventrix and has received research grant funding from Medtronic; AK reports a consulting relationship with Abiomed and being on the medical advisor board for Medtronic; RJT reports consulting relationships with Medtronic, Abbott, Aria CV, Arena Pharmaceuticals, Acceleron, Itamar, Edwards LifeSciences, Eidos Therapeutics, Lexicon Pharmaceuticals, Gradient, and United Therapeutics and is on steering committees for Medtronic, Acceleron and Abbott, is on a research advisory board for Abiomed and does hemodynamic core lab work for Actelion and Merck. All other listed authors have no disclosures to report. Publisher Copyright: {\textcopyright} 2022 Elsevier Inc.",

year = "2022",

month = nov,

doi = "10.1016/j.cardfail.2022.04.016",

language = "English (US)",

volume = "28",

pages = "1584--1592",

journal = "Journal of cardiac failure",

issn = "1071-9164",

publisher = "Elsevier B.V.",

number = "11",

}

TY - JOUR

T1 - Outcomes in Patients With LVADs Undergoing Simultaneous Heart-Kidney Transplantation

AU - Atkins, JESSICA

AU - HESS, NICHOLAS R.

AU - FU, SHENG

AU - READ, JACOB M.

AU - HAJJ, JENNIFER M.

AU - RAMU, BHAVADHARINI

AU - SILVERMAN, DANIEL N.

AU - INAMPUDI, CHAKRADHARI

AU - VANBAKEL, ADRIAN B.

AU - HASHMI, Z. A.

AU - POPE, NICHOLAS H.

AU - WITER, LUCAS P.

AU - KANWAR, MANREET K.

AU - SAUER, ANDREW J.

AU - HOUSTON, BRIAN A.

AU - KILIC, ARMAN

AU - TEDFORD, RYAN J.

N1 - Funding Information: None. No grants, contracts or other financial support were received for this manuscript. CI reports a consulting relationship with Abbott; ABVB reports DSMB committee work for TransMedics and research support from CareDx; AJS reports a consulting relationship with Medtronic, Abbott, Boston Scientific, and Edwards Life Sciences and is on steering committees with Medtronic, Abbott and Boston Scientific; BAH reports consulting relationships with Medtronic and Bioventrix and has received research grant funding from Medtronic; AK reports a consulting relationship with Abiomed and being on the medical advisor board for Medtronic; RJT reports consulting relationships with Medtronic, Abbott, Aria CV, Arena Pharmaceuticals, Acceleron, Itamar, Edwards LifeSciences, Eidos Therapeutics, Lexicon Pharmaceuticals, Gradient, and United Therapeutics and is on steering committees for Medtronic, Acceleron and Abbott, is on a research advisory board for Abiomed and does hemodynamic core lab work for Actelion and Merck. All other listed authors have no disclosures to report. Publisher Copyright: © 2022 Elsevier Inc.

PY - 2022/11

Y1 - 2022/11

N2 - Background: Multiple studies have shown better outcomes for simultaneous heart-kidney transplant (sHKT) than for isolated orthotopic heart transplant (iOHT) in recipients with chronic kidney disease (CKD). However, outcomes in patients supported by durable left ventricular assist devices (LVADs) have not been well studied. Methods: Patients with durable LVADs and stage 3 or higher CKD (eGFR < 60 mL/min/1.73 m2) undergoing iOHT or sHKT between 2008 and 2020 were identified from the United Network for Organ Sharing registry. A Kaplan-Meier survival analysis with associated log-rank test was conducted to compare post-transplant survival rates. Multivariable modeling was used to identify risk-adjusted predictors of 1 year post-transplant mortality. Results: We identified 4375 patients; 366 underwent sHKT, and 4009 underwent iOHT. The frequency of sHKT increased during the study period. The 1-year post-transplant survival rate was worse in patients after sHKT than in patients after iOHT (80.3% vs 88.3%; P < 0.001) and persisted up to 5 years post-transplant (P = 0.001). sHKT recipients were more likely to require dialysis after transplantation and had longer hospital lengths of stay (P < 0.001). Multivariable analysis showed that sHKT remained an independent risk factor for mortality at 1 year (OR 1.58; P = 0.002). Conclusions: sHKT is becoming more common in patients with durable LVADs. Compared with iOHT, patients with sHKTs have worse short- and long-term survival rates and are more likely to require post-transplant dialysis.

AB - Background: Multiple studies have shown better outcomes for simultaneous heart-kidney transplant (sHKT) than for isolated orthotopic heart transplant (iOHT) in recipients with chronic kidney disease (CKD). However, outcomes in patients supported by durable left ventricular assist devices (LVADs) have not been well studied. Methods: Patients with durable LVADs and stage 3 or higher CKD (eGFR < 60 mL/min/1.73 m2) undergoing iOHT or sHKT between 2008 and 2020 were identified from the United Network for Organ Sharing registry. A Kaplan-Meier survival analysis with associated log-rank test was conducted to compare post-transplant survival rates. Multivariable modeling was used to identify risk-adjusted predictors of 1 year post-transplant mortality. Results: We identified 4375 patients; 366 underwent sHKT, and 4009 underwent iOHT. The frequency of sHKT increased during the study period. The 1-year post-transplant survival rate was worse in patients after sHKT than in patients after iOHT (80.3% vs 88.3%; P < 0.001) and persisted up to 5 years post-transplant (P = 0.001). sHKT recipients were more likely to require dialysis after transplantation and had longer hospital lengths of stay (P < 0.001). Multivariable analysis showed that sHKT remained an independent risk factor for mortality at 1 year (OR 1.58; P = 0.002). Conclusions: sHKT is becoming more common in patients with durable LVADs. Compared with iOHT, patients with sHKTs have worse short- and long-term survival rates and are more likely to require post-transplant dialysis.

KW - chronic kidney disease

KW - heart-kidney transplant

KW - Left ventricular assist device

KW - orthotopic heart transplant

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JO - Journal of cardiac failure

JF - Journal of cardiac failure

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ER -

Outcomes in Patients With LVADs Undergoing Simultaneous Heart-Kidney Transplantation

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

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