The Impact of Donor and Recipient Renal Dysfunction on Cardiac Allograft Survival: Insights into Reno-Cardiac Interactions

Olga Laur, Meredith A. Brisco, Alexander J. Kula, Susan J. Cheng, Abeel A. Mangi, Lavanya Bellumkonda, Daniel L. Jacoby, Steven Coca, W. H.Wilson Tang, Chirag R. Parikh, Jeffrey M. Testani

Research output: Contribution to journalArticlepeer-review

Abstract

Background Renal dysfunction (RD) is a potent risk factor for death in patients with cardiovascular disease. This relationship may be causal; experimentally induced RD produces findings such as myocardial necrosis and apoptosis in animals. Cardiac transplantation provides an opportunity to investigate this hypothesis in humans. Methods and Results Cardiac transplantations from the United Network for Organ Sharing registry were studied (n = 23,056). RD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2. RD was present in 17.9% of donors and 39.4% of recipients. Unlike multiple donor characteristics, such as older age, hypertension, or diabetes, donor RD was not associated with recipient death or retransplantation (age-adjusted hazard ratio [HR] = 1.00, 95% confidence interval [CI] 0.94-1.07, P =.92). Moreover, in recipients with RD the highest risk for death or retransplantation occurred immediately posttransplant (0-30 day HR = 1.8, 95% CI 1.54-2.02, P <.001) with subsequent attenuation of the risk over time (30-365 day HR = 0.92, 95% CI 0.77-1.09, P =.33). Conclusions The risk for adverse recipient outcomes associated with RD does not appear to be transferrable from donor to recipient via the cardiac allograft, and the risk associated with recipient RD is greatest immediately following transplant. These observations suggest that the risk for adverse outcomes associated with RD is likely primarily driven by nonmyocardial factors.

Original languageEnglish (US)
Pages (from-to)368-375
Number of pages8
JournalJournal of cardiac failure
Volume22
Issue number5
DOIs
StatePublished - May 1 2016
Externally publishedYes

Keywords

  • Reno-cardiac syndrome
  • cardiac transplantation
  • cardio-renal syndrome
  • renal dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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