Estimated Glomerular Filtration Rate at Transplant Listing and Other Predictors of Post-Heart Transplant Mortality and the Development of ESRD

Abstract

Background. 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. Methods. 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. Results. Compared with the patients on waitlist eGFR ≥60 mL/min/1.73 m2, 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 m2, 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/1.73m2, 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/1.73m2, respectively. Conclusions. Our findings show that risk of ESRD post-heart transplant increases with worsening eGFR at waitlisting even after adjusting for multiple confounders.