Impact of heart disease before kidney transplantation on overall survival and graft function at 12 and 24 months.

A single-center observational study.

Abstract

Introduction: Cardiovascular Disease is considered the leading cause of death in patients with stage 5 chronic kidney disease (CKD), on dialysis and postkidney transplant (KT). There is no optimal pretransplant cardiovascular screening strategy, and most tests are limited to detecting coronary heart disease. The study aimed to measure the impact of pretransplant heart disease on 12- and 24-month overall graft survival.

Methods: A retrospective cohort of patients with TR between 2009 and 2019 recorded cardiovascular history, CKD etiology, cardiac surgeries, echocardiographic, and pretransplant biochemical diagnoses. For outcomes, discharge glomerular filtration rate at 12 and 24 months, number of causes of death, and cardiovascular outcomes at 12 and 24 months were recorded. The variables were analyzed using X ², T test, and Kaplan‒Meier survival.

Results: A total of 326 patients entered the study. 7.7% had a cardiovascular diagnosis before the transplant protocol, 3.6% had a cardiac intervention, 11.4% had LVEF <50%, and valvular disease in 47.7%. Overall survival was 96.9%, and cardiovascular outcomes were 1.5%. At 12 and 24 months 42.4% and 48.3%, respectively, the GFR was <70 ml/min. Overall survival was lower with a history of cardiovascular disease and valvular disease (P < 0.05). graft survival was lower for cardiovascular disease (P < 0.05) and previous cardiac surgery (P <0.05) and higher for LVEF <40% at 12 (P<0.05) and 24 months.

Conclusion: The nonfatal cardiovascular outcome occurred in 1.6%, and the causes of mortality were infectious. Cardiovascular history, cardiac surgery, and pretransplant valvular disease negatively impact overall survival and graft function. Detection of other forms of cardiac disease will lead to a more accurate assessment of posttransplant prognosis regarding graft survival and function.