Impact of kidney transplant on post‐operative morbidity and mortality in patients with pre‐operative cardiac dysfunction

Abstract

Background Several studies show an increase in complications, both cardiac and non‐cardiac, and a higher mortality in patients with preexisting cardiac disease when they undergo elective surgery. Due to the high incidence of cardiac dysfunction in patients with concomitant chronic kidney disease, we wanted to determine if the same negative impact is demonstrated in patients undergoing kidney transplantation. Methods A retrospective analysis was done on 582 patients who underwent kidney transplant from a single transplant center between 2014 and 2019. Participants for this study were divided into two groups based on cardiac ejection fraction: normal EF (≥40%) (n = 540) and low EF (<40%) (n = 33); exclusion criteria included patients undergoing multi‐organ transplants (n = 9). Characteristics and outcomes of patients were compared before and after transplant using chi‐square tests for categorical measures, and either Kruskal–Wallis or paired Student's t tests for continuous measures. Overall survival (OS) between groups was assessed using the Kaplan–Meier test. We compared outcomes between the normal EF and low EF groups using logistic regression in raw data, and propensity score matched sample and inverse‐probability‐weighting to mitigate selection bias. Results There was no significant difference in survival between patients in the low EF and normal EF groups (p = .33). Among patients with low EF, mean EF after transplant significantly improved (mean: 55.83% ± 5.75%) compared to mean EF before transplant (38.28% ± 7.35%), (p = < .0001). Of the patients with a low EF before transplant, 1 in 5 had a history of CAD, compared to only 1 in 10 among those patients with a normal EF, p = .0657. Post‐transplant complications were comparable between the groups. Conclusion Patients undergoing kidney transplantation with a low ejection fraction do not demonstrate an increased incidence of morbidity or mortality in the peri‐ and post‐transplant follow‐up compared with patients with a normal ejection fraction. Cardiac events post‐transplantation is also comparable between the two groups. Of note, patients with a low EF have a significantly improved EF after kidney transplant which is likely a function of improvement in their physiologic state after the kidney transplant.

Abdominal Organ Transplantation: Noteworthy Literature in 2023

“…Additionally, there was no difference in morbidity or mortality following kidney transplant in these patients compared to those with LVEF ≥40%. 17 The utility of cardiovascular screening in asymptomatic patients was another common area of study. Cheng et al demonstrated that pre-transplant testing for coronary heart disease within 12 months of transplantation was not associated with a reduction in the rate of death or acute myocardial infarction within 30 days of kidney transplantation (rate difference: 1.9%; 95% confidence interval (CI): 0%-3.5%) in a quasi-experimental cohort study using instrumental variable analysis of 79,334 kidney transplant recipients of whom 5.3% met one of the primary outcomes.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2022

“…Notably, mean EF improved significantly after transplant compared to pre-transplant in the EF <40% group (55.8% post-transplant vs 38.3% pre-transplant ( P < .0001), suggesting that KTx is beneficial in this population. 34…”

“…33 The effect of heart failure with reduced ejection fraction (EF) on outcomes following KTx was analyzed in a retrospective study of 573 patients. 34 Patients were divided into groups with normal EF (≥40%) and low EF (<40%). Survival at 3 years was similar between the 2 groups (93.7% in EF ≥40% vs 90.9% in EF <40%, P = .46).…”

“…Notably, mean EF improved significantly after transplant compared to pre-transplant in the EF <40% group (55.8% post-transplant vs 38.3% pre-transplant (P < .0001), suggesting that KTx is beneficial in this population. 34 Hypertension (HTN) is one of the most common comorbid conditions in patients with end-stage renal disease (ESRD). While the negative effects of chronic uncontrolled HTN are well established, optimal blood pressure targets in the peritransplant period are less clear, as tight blood pressure control may also lead to graft hypoperfusion in the short term.…”

The Year 2022 in Review and a Glimpse into the Future

“…20 Interestingly, it was also shown this year that patients with heart failure with reduced ejection fraction undergoing renal transplantation demonstrated an improvement in their ejection fraction postoperatively. 21 Rounding out the year in review pertaining to the care of kidney transplant patients was more evidence for the safety and efficacy of Sugammadex use in this population. Here, there was no negative impact on graft function, and Sugammadex administration was associated with shorter recovery room stays and lower rates of postoperative ICU admission and hypoxia.…”