Pre-orthotopic heart transplant estimated glomerular filtration rate predicts post-transplant mortality and renal outcomes: An analysis of the UNOS database

Phillip J. Habib, Parag C. Patel, David Hodge, Nicolette Chimato, Daniel S. Yip, Jeffrey D. Hosenpud, Hani M. Wadei

Research output: Contribution to journalArticle

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Abstract

Background Pre-orthotopic heart (OHT) serum creatinine correlates with post-OHT outcomes, but there is limited information on the relationship between pre-OHT estimated glomerular filtration rate (eGFR) and adjusted short- and long-term survival and renal outcomes post-OHT. Methods Using the United Network of Organ Sharing (UNOS) database we estimated pre-OHT eGFR using the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in patients aged ≥18 years who underwent OHT between 1988 and 2013. Patients were stratified into 5 eGFR categories (≥90, 60 to 89, 45 to 59, 30 to 44 and <30 ml/min/1.73 m2) using each equation. The primary outcome was to determine whether pre-OHT eGFR independently predicted post-OHT mortality. Results A total of 30,090 patients were included in the study; of these, 46.1% and 39.9% had an eGFR <60 ml/min/1.73 m2 by MDRD and CKD-EPI, respectively. Compared with eGFR ≥90 ml/min/1.73 m2, the adjusted hazard ratio of mortality was 1.09 (95% confidence interval [CI] 1.02 to 1.26) for eGFR 45 to 59 ml/min/1.73 m2, 1.22 (95% CI –1.23 to 1.31) for eGFR 30 to 44 ml/min/1.73 m2 and 1.55 (95% CI 1.41 to 1.70) for eGFR <30 ml/min/1.73 m2 by MDRD. There was no advantage for CKD-EPI over MDRD in determining post-OHT mortality. Pre-OHT eGFR by either equation was predictive of post-OHT end-stage renal disease (ESRD) and the need for kidney transplantation, with the highest risk in those with pre-OHT eGFR <30 ml/min/1.73 m2 by either equation. Conclusions Pre-OHT eGFR was independently associated with mortality, ESRD and kidney transplantation after OHT. There was no advantage of CKD-EPI over MDRD in determining post-OHT mortality or renal outcomes.

Original languageEnglish (US)
Pages (from-to)1471-1479
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume35
Issue number12
DOIs
StatePublished - Dec 1 2016

Fingerprint

Glomerular Filtration Rate
Databases
Transplants
Kidney
Mortality
Diet Therapy
Chronic Renal Insufficiency
Epidemiology
Kidney Transplantation
Confidence Intervals
Chronic Kidney Failure
Creatinine

Keywords

  • creatinine based GFR estimation
  • estimated glomerular filtration rate
  • heart transplant outcome
  • kidney function after heart transplantation
  • pre–heart transplant kidney function

ASJC Scopus subject areas

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

Cite this

Pre-orthotopic heart transplant estimated glomerular filtration rate predicts post-transplant mortality and renal outcomes : An analysis of the UNOS database. / Habib, Phillip J.; Patel, Parag C.; Hodge, David; Chimato, Nicolette; Yip, Daniel S.; Hosenpud, Jeffrey D.; Wadei, Hani M.

In: Journal of Heart and Lung Transplantation, Vol. 35, No. 12, 01.12.2016, p. 1471-1479.

Research output: Contribution to journalArticle

Habib, Phillip J. ; Patel, Parag C. ; Hodge, David ; Chimato, Nicolette ; Yip, Daniel S. ; Hosenpud, Jeffrey D. ; Wadei, Hani M. / Pre-orthotopic heart transplant estimated glomerular filtration rate predicts post-transplant mortality and renal outcomes : An analysis of the UNOS database. In: Journal of Heart and Lung Transplantation. 2016 ; Vol. 35, No. 12. pp. 1471-1479.
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abstract = "Background Pre-orthotopic heart (OHT) serum creatinine correlates with post-OHT outcomes, but there is limited information on the relationship between pre-OHT estimated glomerular filtration rate (eGFR) and adjusted short- and long-term survival and renal outcomes post-OHT. Methods Using the United Network of Organ Sharing (UNOS) database we estimated pre-OHT eGFR using the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in patients aged ≥18 years who underwent OHT between 1988 and 2013. Patients were stratified into 5 eGFR categories (≥90, 60 to 89, 45 to 59, 30 to 44 and <30 ml/min/1.73 m2) using each equation. The primary outcome was to determine whether pre-OHT eGFR independently predicted post-OHT mortality. Results A total of 30,090 patients were included in the study; of these, 46.1{\%} and 39.9{\%} had an eGFR <60 ml/min/1.73 m2 by MDRD and CKD-EPI, respectively. Compared with eGFR ≥90 ml/min/1.73 m2, the adjusted hazard ratio of mortality was 1.09 (95{\%} confidence interval [CI] 1.02 to 1.26) for eGFR 45 to 59 ml/min/1.73 m2, 1.22 (95{\%} CI –1.23 to 1.31) for eGFR 30 to 44 ml/min/1.73 m2 and 1.55 (95{\%} CI 1.41 to 1.70) for eGFR <30 ml/min/1.73 m2 by MDRD. There was no advantage for CKD-EPI over MDRD in determining post-OHT mortality. Pre-OHT eGFR by either equation was predictive of post-OHT end-stage renal disease (ESRD) and the need for kidney transplantation, with the highest risk in those with pre-OHT eGFR <30 ml/min/1.73 m2 by either equation. Conclusions Pre-OHT eGFR was independently associated with mortality, ESRD and kidney transplantation after OHT. There was no advantage of CKD-EPI over MDRD in determining post-OHT mortality or renal outcomes.",
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T1 - Pre-orthotopic heart transplant estimated glomerular filtration rate predicts post-transplant mortality and renal outcomes

T2 - An analysis of the UNOS database

AU - Habib, Phillip J.

AU - Patel, Parag C.

AU - Hodge, David

AU - Chimato, Nicolette

AU - Yip, Daniel S.

AU - Hosenpud, Jeffrey D.

AU - Wadei, Hani M.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Background Pre-orthotopic heart (OHT) serum creatinine correlates with post-OHT outcomes, but there is limited information on the relationship between pre-OHT estimated glomerular filtration rate (eGFR) and adjusted short- and long-term survival and renal outcomes post-OHT. Methods Using the United Network of Organ Sharing (UNOS) database we estimated pre-OHT eGFR using the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in patients aged ≥18 years who underwent OHT between 1988 and 2013. Patients were stratified into 5 eGFR categories (≥90, 60 to 89, 45 to 59, 30 to 44 and <30 ml/min/1.73 m2) using each equation. The primary outcome was to determine whether pre-OHT eGFR independently predicted post-OHT mortality. Results A total of 30,090 patients were included in the study; of these, 46.1% and 39.9% had an eGFR <60 ml/min/1.73 m2 by MDRD and CKD-EPI, respectively. Compared with eGFR ≥90 ml/min/1.73 m2, the adjusted hazard ratio of mortality was 1.09 (95% confidence interval [CI] 1.02 to 1.26) for eGFR 45 to 59 ml/min/1.73 m2, 1.22 (95% CI –1.23 to 1.31) for eGFR 30 to 44 ml/min/1.73 m2 and 1.55 (95% CI 1.41 to 1.70) for eGFR <30 ml/min/1.73 m2 by MDRD. There was no advantage for CKD-EPI over MDRD in determining post-OHT mortality. Pre-OHT eGFR by either equation was predictive of post-OHT end-stage renal disease (ESRD) and the need for kidney transplantation, with the highest risk in those with pre-OHT eGFR <30 ml/min/1.73 m2 by either equation. Conclusions Pre-OHT eGFR was independently associated with mortality, ESRD and kidney transplantation after OHT. There was no advantage of CKD-EPI over MDRD in determining post-OHT mortality or renal outcomes.

AB - Background Pre-orthotopic heart (OHT) serum creatinine correlates with post-OHT outcomes, but there is limited information on the relationship between pre-OHT estimated glomerular filtration rate (eGFR) and adjusted short- and long-term survival and renal outcomes post-OHT. Methods Using the United Network of Organ Sharing (UNOS) database we estimated pre-OHT eGFR using the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in patients aged ≥18 years who underwent OHT between 1988 and 2013. Patients were stratified into 5 eGFR categories (≥90, 60 to 89, 45 to 59, 30 to 44 and <30 ml/min/1.73 m2) using each equation. The primary outcome was to determine whether pre-OHT eGFR independently predicted post-OHT mortality. Results A total of 30,090 patients were included in the study; of these, 46.1% and 39.9% had an eGFR <60 ml/min/1.73 m2 by MDRD and CKD-EPI, respectively. Compared with eGFR ≥90 ml/min/1.73 m2, the adjusted hazard ratio of mortality was 1.09 (95% confidence interval [CI] 1.02 to 1.26) for eGFR 45 to 59 ml/min/1.73 m2, 1.22 (95% CI –1.23 to 1.31) for eGFR 30 to 44 ml/min/1.73 m2 and 1.55 (95% CI 1.41 to 1.70) for eGFR <30 ml/min/1.73 m2 by MDRD. There was no advantage for CKD-EPI over MDRD in determining post-OHT mortality. Pre-OHT eGFR by either equation was predictive of post-OHT end-stage renal disease (ESRD) and the need for kidney transplantation, with the highest risk in those with pre-OHT eGFR <30 ml/min/1.73 m2 by either equation. Conclusions Pre-OHT eGFR was independently associated with mortality, ESRD and kidney transplantation after OHT. There was no advantage of CKD-EPI over MDRD in determining post-OHT mortality or renal outcomes.

KW - creatinine based GFR estimation

KW - estimated glomerular filtration rate

KW - heart transplant outcome

KW - kidney function after heart transplantation

KW - pre–heart transplant kidney function

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