title: Does renal dysfunction and method of bridging support influence heart transplant graft survival?
abstract: BACKGROUND
  Renal insufficiency is common in status 1B patients supported with inotropes or a continuous flow left ventricular device (CF-LVAD) as a bridge to heart transplantation. We evaluated the association of renal function and inotrope versus CF-LVAD support on posttransplant graft survival in status 1B patients.
  
  
  METHODS
  The Scientific Registry for Transplant Recipients database was analyzed for posttransplant survival in status 1B patients bridged with inotropes or CF-LVAD who underwent transplantation between 2003 and 2012. Pretransplant renal function was measured by estimating glomerular filtration rate (GFR) and was stratified as less than 45 mL · min(-1) · 1.73 m(-2), 45 to 59, and 60 or greater. Univariate Kaplan-Meier and multivariate Cox regression models were used to evaluate the main effects of GFR strata and inotropes versus CF-LVAD, and the interaction effect of GFR strata by CF-LVAD, on graft survival.
  
  
  RESULTS
  This study included 4,158 status 1B patients (74% male, aged 53 ± 12 years). Of those, 659 patients had a CF-LVAD (HeartMate-II [Thoratec, Pleasanton, CA], n = 638; HVAD [HeartWare, Framingham, MA], n = 21), and 3,530 were receiving inotropes (31 CF-LVAD patients were also receiving inotropes). Kaplan-Meier analyses demonstrated reduced graft survival (p = 0.022) in patients with pretransplant GFR less than 45 versus GFR 45 to 59 (p = 0.062) and versus GFR 60 or greater (p = 0.007), and no effect of inotrope versus CF-LVAD support on graft survival (p = 0.402). Multivariate analysis demonstrated that, after adjusting for the main effects of GFR stratum, CF-LVAD, and inotropes, status 1B patients bridged with a CF-LVAD and GFR in the lowest stratum had reduced graft survival (interaction effect p = 0.040).
  
  
  CONCLUSIONS
  Pretransplant renal insufficiency was associated with reduced posttransplant graft survival in status 1B patients. This risk is increased for patients bridged with a CF-LVAD (versus inotropes) who have GFR in the lowest stratum.
authors: Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Nicholas A
authors: NA
authors: Haglund
authors: Departments of Surgery and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Irene D
authors: ID
authors: Feurer
authors: Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Jamie P
authors: JP
authors: Dwyer
authors: Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors: John M
authors: JM
authors: Stulak
authors: Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Thomas G
authors: TG
authors: DiSalvo
authors: Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Mary E
authors: ME
authors: Keebler
authors: Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Kelly H
authors: KH
authors: Schlendorf
authors: Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Mark A
authors: MA
authors: Wigger
authors: Division of Cardiovascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: simon.maltais@vanderbilt.edu.
authors: Simon
authors: S
authors: Maltais
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D005260:Female; D006085:Graft Survival; D006333:Heart Failure / Q000150:complications* / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D051437:Renal Insufficiency / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D002316:Cardiotonic Agents