Tricuspid Regurgitation and Kidney Transplant Recipient Outcomes.

RATIONALE & OBJECTIVE: Kidney function can be adversely affected by significant tricuspid regurgitation (TR) owing to effects on cardiac output and systemic venous congestion. However, the impact of significant TR on short- and long-term kidney function following a kidney transplant remains uncertain.

STUDY DESIGN

Retrospective observational cohort.

SETTING & PARTICIPANTS: Kidney transplant recipients from a single center between 2016 and 2019.

EXPOSURE

Significant TR, defined by at least moderate regurgitation, on echocardiogram before kidney transplantation.

OUTCOMES

Primary end points included the estimated glomerular filtration rate (eGFR) at the following 3 time points: 2 weeks, 3 months, and 1 year after transplantation. Secondary end points included major adverse cardiac events including nonfatal myocardial infarction, all-cause mortality, and hospitalization owing to cardiovascular disease.

ANALYTICAL APPROACH

Propensity score matching was performed in 1:3 ratio between patients treated with significant TR and controls, within a caliper 0.05 standard deviation of the propensity score, to analyze for the primary end point.

RESULTS

Among 557 kidney transplant recipients, 26 (5%) exhibited significant TR pretransplantation. According to propensity score matching analysis, with 1:3 ratio between 24 patients with significant TR and 72 controls, the presence of significant TR was associated with a lower eGFR posttransplantation. Specifically, the mean eGFR was 41.2 mL/min/1.73 m compared to 53.3 mL/min/1.73 m at 2 weeks ( < 0.01), 50.0 mL/min/1.73 m versus 60.3 mL/min/1.73 m at 3 months ( < 0.01), and 49.4 mL/min/1.73 m versus 61.2 mL/min/1.73 m at 1 year ( < 0.01). Delayed graft function was observed in 41.7% of the patients with significant TR compared to 12.5% of those without significant TR ( < 0.01). No patients with significant TR required dialysis after 1 year. 1-year major adverse cardiac events were nonsignificantly higher among patients with significant TR (20.8% vs 8.1%;  = 0.16).

LIMITATIONS

Retrospective design and relatively small TR population.

CONCLUSIONS

The presence of significant TR among kidney transplant recipients was associated with a lower eGFR at 2 weeks, 3 months, and 1 year following transplant, although all remained dialysis independent at 1 year.