Table 1.
Characteristics and outcomes of the HT alone recipients (eGFR ≤60 ml/min per 1.73 m2 at listing and/or before transplant) between 2000 and 2019 by composite renal outcomes at 1 year in the United States
| Recipient characteristics | Whole cohort | No-CRO | CRO | P valuea |
|---|---|---|---|---|
| n (%) | 19,861 | 19,708 (96.1) | 783 (3.9) | |
| Age, median (IQR) yr | 59 (51–64) | 59 (51–64) | 59 (52–64) | 0.17 |
| Sex (male) | 14,761 (74.3) | 14,195 (74.4) | 566 (72.3) | 0.18 |
| Race | <0.001 | |||
| White | 14,395 (72.5) | 13,883 (72.8) | 512 (65.4) | |
| Black | 3415 (17.2) | 3215 (16.9) | 200 (25.5) | |
| Hispanic | 1302 (6.6) | 1257 (6.6) | 45 (5.8) | |
| Asian | 524 (2.6) | 505 (2.6) | 19 (2.4) | |
| Other | 225 (1.1) | 218 (1.1) | 7 (0.9) | |
| Recipient height (cm) | 173.9 ± 9.8 | 173.9 ± 9.8 | 173.4 ± 10.1 | 0.16 |
| Recipient weight (kg) | 83.4 ± 17.4 | 83.3 ± 17.4 | 85.2 ± 17.8 | 0.003 |
| Body mass index (kg/m2) | 27.5 ± 4.8 | 27.4 ± 4.8 | 28.2 ± 5.0 | <0.001 |
| History of diabetes | <0.001 | |||
| No | 13,932 (70.2) | 13,463 (70.6) | 469 (59.9) | |
| Type I | 382 (1.9) | 362 (1.9) | 20 (2.6) | |
| Type II | 5547 (27.9) | 5253 (27.5) | 294 (37.6) | |
| Etiology of cardiomyopathy | 0.34 | |||
| Ischemic | 7815 (39.4) | 7510 (39.4) | 305 (39.0) | |
| Nonischemic | 7433 (37.4) | 7155 (37.5) | 278 (35.5) | |
| Congenital | 416(2.1) | 401 (2.1) | 15 (1.9) | |
| Otherb | 4197 (21.1) | 4012 (21.0) | 185 (23.6) | |
| Previous HT, n (%) | 695 (3.5) | 663 (3.5) | 32 (4.1) | 0.36 |
| Cardiac output, l/min | 4.54 ± 1.46 | 4.54 ± 1.46 | 4.76 ± 1.53 | <0.001 |
| Cardiac index, l/min per m2 | 2.31 ± 0.70 | 2.30 ± 0.70 | 2.21 ± 0.67 | <0.001 |
| Pulmonary capillary wedge pressure, mm Hg | 18.8 ± 8.6 | 18.8 ± 8.6 | 18.5 ± 8.4 | 0.33 |
| Pulmonary artery mean pressure, mm Hg | 28.3 ± 9.9 | 28.3 ± 9.9 | 28.1 ± 9.3 | 0.58 |
| Mechanical ventilation requirement | 462 (2.3) | 437 (2.3) | 25 (3.2) | 0.10 |
| ECMO | 207 (1.0) | 190 (1.0) | 17 (2.2) | 0.002 |
| IABP | 1536 (7.7) | 1463 (7.7) | 73 (9.3) | 0.09 |
| VAD | <0.001 | |||
| None | 11,698 (58.9) | 11,306 (59.3) | 392 (50.1) | |
| LVAD alone | 6530 (32.9) | 6234 (32.7) | 296 (37.8) | |
| RVAD/BiVAD/TAH | 864 (4.4) | 797 (4.2) | 67 (8.6) | |
| Unknown | 769 (3.9) | 741 (3.9) | 28 (3.6) | |
| eGFR, ml/min per 1.73 m2 at listing (if not on dialysis) | 54.3 ± 17.6 | 54.5 ± 17.5 | 50.9 ± 18.7 | <0.001 |
| eGFR, ml/min per 1.73 m2 before transplant (if not on dialysis) | 53.3 ± 17.6 | 54.5 ± 17.6 | 45.8 ± 17.0 | <0.001 |
| eGFR ratio (before transplant/wait listing) | 1.10 ± 0.90 | 1.10 ± 0.91 | 0.99 ± 0.45 | <0.001 |
| Dialysis at listing, n (%) | 370 (1.9) | 339 (1.8) | 31 (4.0) | <0.001 |
| Dialysis before transplant, n (%) | 1038 (5.2) | 907 (4.8) | 131 (16.7) | <0.001 |
| Functional status by Karnofsky score before transplant, % | <0.001 | |||
| 80–100 | 3309 (16.7) | 3213 (16.8) | 96 (12.3) | |
| 51–79 | 6839 (34.4) | 6603 (34.6) | 316 (40.4) | |
| 0–50 | 8237 (41.5) | 7824 (41.0) | 396 (50.6) | |
| Unknown | 1476 (7.4) | 1438 (7.5) | 38 (4.9) | |
| UNOS region | <0.001 | |||
| 1 | 989 (4.5) | 865 (4.5) | 33 (4.2) | |
| 2 | 2371 (11.9) | 2229 (11.7) | 142 (18.1) | |
| 3 | 2233 (11.4) | 2177 (11.4) | 56 (7.2) | |
| 4 | 2340 (11.8) | 2252 (11.8) | 88 (11.2) | |
| 5 | 3136 (15.8) | 3017 (15.8) | 119 (15.2) | |
| 6 | 656 (3.3) | 640 (3.4) | 16 (2.0) | |
| 7 | 1900 (9.6) | 1831 (9.6) | 69 (8.8) | |
| 8 | 1107 (5.6) | 1067 (5.6) | 40 (5.1) | |
| 9 | 1202 (6.1) | 1127 (5.9) | 75 (9.6) | |
| 10 | 1626 (8.2) | 1583 (8.3) | 43 (5.5) | |
| 11 | 2392 (12.0) | 2290 (12.0) | 102 (13.0) | |
| Waitlisted time (including inactive status), median (IQR), d | 87 (25–251) | 87 (25–250) | 104 (27–285) | |
| Post-transplant patient survival at 1 yr (based on Kaplan Meier estimates), % | 87.3 | 88.3 | 71.0 | <0.001 |
| Composite renal outcome incidence within 1 yr of heart transplantation, mean (the year 2000, the year 2019), % | 3.9 (2.6–6.1) |
Data are presented as n (%), median (IQR) as appropriate.
BiVAD, biventricular assist device; CABG, coronary artery bypass graft; CRO, composite renal outcome; ECMO, extracorporeal membrane oxygenation; eGFR, estimated glomerular filtration rate; HT, heart transplant; IABP, intra-aortic balloon pump; IQR, interquartile range; LV, left ventricular; LVAD, left ventricular assist device; TAH, total artificial heart; UNOS, United Network of Organ Sharing; VAD, ventricular assist device.
P value applies to the comparison of no-CRO and CRO groups.
Other: restrictive cardiomyopathy, congenital, arrhythmia, valvular, and heart transplant-related diagnosis.