Department of Internal Medicine, University of Vermont, Burlington, VT.
Department of Statistical Software Support and Consulting Services, University of Vermont, Burlington, VT.
Transplantation. 2020 Nov;104(11):2444-2452. doi: 10.1097/TP.0000000000003159.
Elevated serum creatinine at the time of heart transplant is an independent predictor of posttransplant end-stage renal disease (ESRD) and mortality. Patients who are at risk of ESRD should be identified before transplantation. We looked at the severity of CKD at the time of waitlisting on posttransplant ESRD and mortality.
We analyzed the United Network of Organ Sharing transplant database from 2000 to 2017. Adults receiving their first heart transplant, and not on dialysis, were included in study. We divided our cohort into 4 groups based on their listing estimated glomerular filtration (eGFR) as well as based on their eGFR at the time of transplant. Primary outcome was all cause mortality and secondary outcome was ESRD.
Compared with the patients on waitlist eGFR ≥60 mL/min/1.73 m, the adjusted subdistribution hazard for ESRD was 1.41 (confidence interval [CI], 1.2-1.5), 2.15 (CI, 1.9-2.4), and 2.91 (CI, 2.4-3.5) in the patient groups with eGFR of 45-59, 30-44, and <30 mL/min/1.73 m, respectively. Despite the highest risk of ESRD with the lowest baseline eGFR group, there was a substantial increase in eGFR seen during follow-up with a mean gain of 11 mL/min by year 15 compared with a mean loss of 10 mL/min in the highest eGFR group. Compared with the patients on waitlist eGFR ≥60 mL/min/1.73m, the adjusted hazard ratio for mortality was 1.04 (0.98-1.11), 1.07 (1.00-1.15), and 1.04 (0.91-1.19) in the patient groups with eGFR of 45-59, 30-44, and <30 mL/min/1.73m, respectively.
Our findings show that risk of ESRD post-heart transplant increases with worsening eGFR at waitlisting even after adjusting for multiple confounders.
心脏移植时血清肌酐升高是移植后终末期肾病（ESRD）和死亡的独立预测因素。应在移植前识别有 ESRD 风险的患者。我们观察了等待移植时 CKD 的严重程度与移植后 ESRD 和死亡率的关系。
我们分析了 2000 年至 2017 年期间的 United Network of Organ Sharing 移植数据库。纳入首次接受心脏移植且未接受透析的成人患者进行研究。我们根据他们的等待名单估计肾小球滤过率（eGFR）将队列分为 4 组，并根据他们移植时的 eGFR 进行分组。主要结果是全因死亡率，次要结果是 ESRD。
与等待名单 eGFR≥60ml/min/1.73m 的患者相比，eGFR 为 45-59、30-44 和<30ml/min/1.73m 的患者组，调整后的亚分布危险比（HR）分别为 1.41（95%置信区间[CI]，1.2-1.5）、2.15（95%CI，1.9-2.4）和 2.91（95%CI，2.4-3.5）。尽管 eGFR 最低的患者组发生 ESRD 的风险最高，但在随访期间 eGFR 有显著升高，与 eGFR 最高的患者组相比，每年增加 11ml/min，而 eGFR 最高的患者组每年降低 10ml/min。与等待名单 eGFR≥60ml/min/1.73m 的患者相比，eGFR 为 45-59、30-44 和<30ml/min/1.73m 的患者组，调整后的死亡率 HR 分别为 1.04（95%CI，0.98-1.11）、1.07（95%CI，1.00-1.15）和 1.04（95%CI，0.91-1.19）。
我们的研究结果表明，即使在调整了多个混杂因素后，等待移植时 eGFR 恶化与心脏移植后 ESRD 风险增加相关。
