title: The outcome of heart transplant recipients following the development of end-stage renal disease: analysis of the Canadian Organ Replacement Register (CORR).
abstract: End-stage renal disease is a significant complication of heart transplantation (HTx), but our understanding of dialysis outcomes in HTx recipients remains limited. We performed a retrospective analysis looking at dialysis mortality in HTx recipients as compared to a matched dialysis cohort. We also examined outcomes with respect to kidney transplantation (KTx) in these cohorts. 2709 incident HTx recipients were captured from the Canadian Organ Replacement Register between 1981 and 2002. The incidence of dialysis after HTx was 3.9% (n = 105) and carried a greater crude mortality compared to HTx recipients not requiring dialysis (56.2% vs. 35.9%, p < 0.001). Compared to the matched dialysis cohort, survival of HTx patients on dialysis was also significantly worse (19% vs. 40%, p = 0.003). In those receiving a KTx, survival did not differ between the two cohorts; however, in those that did not receive a KTx the survival was significantly lower in the dialysis post-HTx group compared to the matched dialysis cohort (15.7% vs. 35.2%, p < 0.025). Our analysis suggests mortality on dialysis following HTx is greater than would be expected from a similar dialysis population, and KTx may abrogate some of this increased risk. Attention should be placed on preventing chronic kidney disease progression following HTx.
authors.affiliation: Multiorgan Transplant Program, Department of Medicine, Royal Victoria Hospital, McGill University Health Centre, Montreal, Québec, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Alam
authors.forename: K
authors.initials: K
authors.lastname: Badovinac
authors.forename: F
authors.initials: F
authors.lastname: Ivis
authors.forename: L
authors.initials: L
authors.lastname: Trpeski
authors.forename: M
authors.initials: M
authors.lastname: Cantarovich
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000401:mortality* / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate