Affiliation:
1. Department of Cardiovascular Medicine Graduate School of Medicine The University of Tokyo Bunkyo‐ku Tokyo Japan
2. Department of Therapeutic Strategy for Heart Failure Graduate School of Medicine The University of Tokyo Bunkyo‐ku Tokyo Japan
3. Department of Advanced Medical Center for Heart Failure Graduate School of Medicine The University of Tokyo Bunkyo‐ku Tokyo Japan
4. Department of Cardiac Surgery Graduate School of Medicine The University of Tokyo Bunkyo‐ku Tokyo Japan
Abstract
AbstractAimWe investigated the effects of pre‐transplantation renal dysfunction under left ventricular assisted device (LVAD) support on post‐transplantation cardiac function, and patient prognosis after heart transplantation (HTx).MethodAll patients who were bridged by LVAD and underwent HTx at our hospital between 2007 and 2022 were included in this study. Patients were classified into two groups based on estimated glomerular filtration rate (eGFR) before HTx: renal dysfunction (RD) group (eGFR < 60 mL/min/1.73 m2) and non‐renal dysfunction (NRD) group.ResultA total of 132 patients were analyzed, of whom 48 were classified into the RD group and 84 into the NRD group (RD group, 47.9 ± 10.1 years; NRD group, 38.4 ± 11.9 years, p < .0001). Under LVAD support before HTx, the RD group tended to have a history of right ventricular failure (RD group, nine (19%); NRD group, seven (8%); p = .098). After HTx, the echocardiographic parameters did not differ between the two groups in the long term. Furthermore, more concise hemodynamic parameters, exemplified by right heart catheterization, were not significantly different between the two groups. Regarding graft rejection, no significant differences were found in acute cellular rejection and cardiac allograft vasculopathy following HTx. In contrast, patients with RD before HTx had significantly increased mortality in the chronic phase after HTx and initiation of maintenance dialysis, without any overt changes in cardiac function.ConclusionPre‐transplantation renal dysfunction under LVAD support significantly affected clinical course after HTx without any overt changes in graft cardiac function.