Evidence supports severe renal insufficiency as a relative contraindication to heart transplantation.
This study was conducted to determine whether survival after orthotopic heart transplant (OHT) is associated with pre-transplant estimated glomerular filtration rate (eGFR) and to define ranges of pre-OHT eGFR associated with differences in post-transplant survival. The 2006 International Society for Heart and Lung Transplantation revised listing criteria for OHT stated that chronic kidney disease, defined by an eGFR <40 ml/min is a relative contraindication for OHT alone. The committee noted that this recommendation was supported by consensus opinion of experts and not data derived from a randomized trial or non-randomized studies.



The United Network for Organ Sharing provided deidentified patient-level data. The study population included 17,459 OHT recipients aged ≥18 years who received allografts between January 1, 2001, and December 31, 2009. Logistic regression was used to assess the effect of multiple variables on survival after OHT. Receiver operating characteristic curves and stratum-specific likelihood ratios were generated to compare 1-year survival at eGFR thresholds. The primary outcomes measure was actuarial post-transplant survival expressed in years.



Regression analysis showed that a lower pre-transplant eGFR is associated with worse post-transplant survival. Threshold analysis demonstrated 3 distinct survival strata: eGFR ≤ 34 ml/min, eGFR 35 to 49 ml/min, and eGFR > 49 ml/min. Graft survival at all times is decreased for patients with eGFR ≤ 34 ml/min. They are also more likely to have in-hospital and long-term complications.



eGFR is a strong predictor of post-transplant survival and should be considered when assessing patients for OHT. This analysis supports current International Society for Heart and Lung Transplantation guidelines and suggests that end-stage heart failure patients with an eGFR ≤ 34 ml/min is a relative contraindication for heart transplantation alone.
Department of Cardiology, Mount Sinai School of Medicine, New York, New York.
Kimberly N
KN
Hong
Case Western Reserve Medical School, Cleveland, Ohio.
Aurelie
A
Merlo
Department of Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey; Cardiovascular Clinical Research Unit, Barnabas Heart Hospitals, Newark, New Jersey. Electronic address: dhavalchauhan86@gmail.com.
Dhaval
D
Chauhan
Division of Pediatric Cardiothoracic Surgery, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware.
Ryan R
RR
Davies
Department of Cardiothoracic Surgery, Dartmouth Medical Center, Hanover, New Hampshire.
Alexander
A
Iribarne
Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois.
Elizabeth
E
Johnson
Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois.
Val
V
Jeevanandam
Department of Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey; Cardiovascular Clinical Research Unit, Barnabas Heart Hospitals, Newark, New Jersey.
Mark J
MJ
Russo
D000075202:Contraindications; D005919:Glomerular Filtration Rate; D016027:Heart Transplantation; D006801:Humans; D051437:Renal Insufficiency; D012189:Retrospective Studies
chronic kidney disease; estimated glomerular filtration rate; mortality; orthotopic heart transplant; outcomes; renal insufficiency