Renal function and outcome after heart transplantation

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Presentation transcript:

Renal function and outcome after heart transplantation Oscar Kolsrud, MD, Kristjan Karason, MD, PhD, Erik Holmberg, MSc, PhD, Sven-Erik Ricksten, MD, PhD, Marie Felldin, MD, Ola Samuelsson, MD, PhD, Göran Dellgren, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 155, Issue 4, Pages 1593-1604.e1 (April 2018) DOI: 10.1016/j.jtcvs.2017.11.087 Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Diagram illustrating the inclusion and exclusion of patients in the study population. At the bottom of the figure are listed the numbers available for analyses for each group of parameter, as well as missing values within each group. HTx, Heart transplantation; CRRT, continuous renal replacement therapy; ESRD, end-stage renal disease; KTx, kidney transplantation; GFR, glomerular filtration rate. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1593-1604.e1DOI: (10.1016/j.jtcvs.2017.11.087) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 The long-term change in kidney function (measured GFR [mGFR]) after heart transplantation (HTx), expressed as percentage of preoperative mGFR. The average preoperative mGFR was 63.4 ± 17.3 mL/min/1.73 m2. After HTx, the mGFR as a percentage of baseline mGFR decreased to 88% at 1 year, 77% at 5 years, 69% at 10 years, 57% at 5 years, and 38% at 20 years. During follow up, 129 patients (43%) had an mGFR of <30 mL/min/1.73 m2 at least once. GFR, Glomerular filtration rate. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1593-1604.e1DOI: (10.1016/j.jtcvs.2017.11.087) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Survival of patients requiring early postoperative continuous renal replacement therapy (CRRT) in the intensive care unit after heart transplantation (HTx). Mortality was significantly higher in this group than in those without early renal failure, particularly during the first weeks/months (hazard ratio, 1.71; 95% confidence interval [CI], 1.24–2.36; P = .0009, log-rank test). The shaded area around the curves illustrates the 95% CI. HTx, Heart transplantation. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1593-1604.e1DOI: (10.1016/j.jtcvs.2017.11.087) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Pepe and Mori test comparing the cumulative incidence of events in the patients who received early postoperative continuous replacement treatment (CRRT) in the intensive care unit and those who did not. Those requiring early CRRT had a significantly increased risk for mortality (P = .006), but the difference in later development of end-stage renal disease (ESRD) was not significant (P = .09). Thus, those patients who survive early dialysis-dependent acute renal failure do not have an increased risk for later development of ESRD. The shaded area around the curves represents the 95% confidence interval. HTx, Heart transplantation. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1593-1604.e1DOI: (10.1016/j.jtcvs.2017.11.087) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Long-term survival conditioned on 1 year and stratified for different levels of glomerular filtration rate (GFR) decline during the first postoperative year (P = .073, log-rank test). In this analysis, only patients alive after 1 year were included, stratified according to GFR decline. The shaded area around the curves represents the 95% confidence interval. HTx, Heart transplantation. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1593-1604.e1DOI: (10.1016/j.jtcvs.2017.11.087) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Cumulative incidence of chronic renal failure over time stratified for era. The Pepe and Mori test was used to compare cumulative incidences of the competing events end-stage renal disease (ESRD) and death without previous ESRD. The competing event death without previous ESRD was significantly lower (P < .001) in the most recent period compared with earlier periods. The shaded area around the curves represents the 95% confidence interval. HTx, Heart transplantation. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1593-1604.e1DOI: (10.1016/j.jtcvs.2017.11.087) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Survival after heart transplantation was significantly higher in the later time era compared with both previous eras combined (hazard ratio, 0.55; 95% confidence interval [CI], 0.35-0.86; P = .002, log-rank test). The shaded area around the curves represents the 95% CI. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1593-1604.e1DOI: (10.1016/j.jtcvs.2017.11.087) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Probability of survival after the development of end-stage renal disease after heart transplantation. Survival was 70% after 1 year, 35% after 5 years, and 24% after 10 years. The shaded area around the curves represents the 95% confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1593-1604.e1DOI: (10.1016/j.jtcvs.2017.11.087) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Survival after HTx of patients stratified for preoperative mGFR Survival after HTx of patients stratified for preoperative mGFR. There was no significant difference in long-term survival among patients with a preoperative mGFR <30 (group 1), those with an mGFR between 30 and 60 mL/min/1.73 m2 (group 2), and those with an mGFR ≥60 mL/min/1.73 m2 (group 3) (P = .60, log-rank test). The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1593-1604.e1DOI: (10.1016/j.jtcvs.2017.11.087) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Video 1 The first author presenting a short abstract of the study, highlighting its central findings and conclusions. Video available at: http://www.jtcvsonline.org/article/S0022-5223(17)32849-0/fulltext. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1593-1604.e1DOI: (10.1016/j.jtcvs.2017.11.087) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions