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The Impact of Severe Acute Kidney Injury Requiring Renal Replacement Therapy on Survival and Renal Function of Heart Transplant Recipients – A UK Cohort Study

Lookup NU author(s): Dr Gareth Parry, Professor John Dark, Professor Neil Sheerin

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Abstract

Background: Severe acute kidney injury (AKI), defined as requiring renal replacement therapy (RRT), is associated with higher mortality post-heart transplantation, but its long-term renal consequences are not known. Methods: Anonymised data of 3365 patients, who underwent heart transplantation between 1995 and 2017, were retrieved from the UK Transplant Registry. Multivariable binary logistic regression was performed to identify risk factors for severe AKI requiring RRT, Kaplan-Meier analysis to compare survival and renal function deterioration of the RRT and non-RRT groups, and multivariable Cox regression model to identify predicting factors of mortality and end-stage renal disease (ESRD). Results: 26.0% of heart recipients received RRT post-transplant. The RRT group has lower survival rates at all time points, especially in the immediate post-transplant period. However, conditional on 3 months survival, older age, diabetes, and coronary heart disease, but not post-transplant RRT, were the risk factors for long-term survival. The predicting factors for ESRD were insulin-dependent diabetes, renal function at transplantation, eGFR decline in the first 3 months post-transplant, post-transplant severe AKI, and transplantation era. Conclusions: Severe AKI requiring RRT post-transplant is associated with worse short-term survival, but has no impact on long-term mortality. It also accelerates recipients’ renal function deterioration in the long term.


Publication metadata

Author(s): Wang L, Wang T, Rushton SN, Parry G, Dark JH, Sheerin NS

Publication type: Article

Publication status: Published

Journal: Transplant International

Year: 2020

Pages: epub ahead of print

Online publication date: 16/06/2020

Acceptance date: 08/06/2020

Date deposited: 09/06/2020

ISSN (electronic): 1432-2277

Publisher: Wiley

URL: https://doi.org/10.1111/tri.13675

DOI: 10.1111/tri.13675


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