Combined Heart-Kidney Transplantation: Vasoplegia is Associated with Poorer Post-Kidney Transplant Outcomes

J. A. Steadman, J. M. Stulak, A. L. Clavell, S. S. Kushwaha, B. S. Edwards, N. L. Pereira, Shannon M Dunlay, John A Schirger, R. P. Frantz, B. H. Smith, P. G. Dean, Richard C Daly

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE: Candidate selection for multi-organ transplants should consider the chances of good function and benefit of all transplanted organs. Risk factors for early renal graft dysfunction after combined heart-kidney transplant (CHKTx) may include vasoplegia and vasopressor need in spite of good cardiac graft function. We aimed to identify risk factors for vasoplegia after CHKTx and its impact on postoperative and renal allograft outcomes. METHODS: A retrospective review was conducted on 58 consecutive patients who underwent CHKTx at a single center between 1996 and 2019. Baseline characteristics, perioperative complications including post-transplant vasoplegia, graft function, and survival were assessed. Vasoplegia was defined as needing vasopressors to maintain a MAP >70 mmHg with either an ejection fraction >55% or a cardiac index ≥2.0 L/min/m2 within 48 hours of transplantation. RESULTS: The mean transplant age was 53.6 years (± 11.3 SD). Pre-transplant, 17 (29.3%) patients had a left ventricular assist device (VAD) and 1 (1.7%) had a right VAD. The operative mortality rate was 5.2% (3 patients). Seventeen (32.1%) patients experienced vasoplegia; of these, 10 (58.8%) had a VAD pre-transplant, 9 (52.9%) had delayed renal graft function (DGF), and 3 (17.6%) had permanent renal graft failure (PGF). All 3 patients with PGF had vasoplegia and 9 (50.0%) with DGF had vasoplegia. Eight (66.7%) of the patients with either DGF or PGF and vasoplegia had a VAD. Further survival analyses shown in table 1. CONCLUSION: Vasoplegia is associated with a higher risk of renal allograft dysfunction following CHKTx, and is frequently associated with LVAD as a bridge to transplant. Identifying further risk factors associated with poor post-CHKTx renal graft function could help define patients for whom CHKTx is appropriate. A review of the CHKTx allocation process in high risk patient groups is warranted.

Original languageEnglish (US)
Pages (from-to)S267
JournalJournal of Heart and Lung Transplantation
Volume39
Issue number4
DOIs
StatePublished - Apr 1 2020

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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