Effect Of Different Treatment Modalities For End-Stage Renal Disease After Heart Transplantation

H.P. Roest, D.A. Hesselink, I. Kardys, K. Caliskan, J.J. Brugts, A.P.W.M. Maat, A.A. Constantinescu, O.C. Manintveld

Friday 16 march 2018

11:00 - 11:10h at Van Rijck/Ruys Zaal

Categories: Clinical

Parallel session: Parallel session 15: Clinical

Aim

End-Stage Renal Disease (ESRD) is a frequent complication of heart transplantation (HTx). The aim of this study was to determine the long-term incidence of ESRD and to investigate what subsequent therapy showed the best survival.

Methods

A retrospective, single-center, descriptive study was performed of 685 HTx recipients to investigate the incidence of ESRD, its effect on patient survival, and the optimal mode of renal replacement therapy (RRT). Of the 685 HTx recipients 133 patients were excluded. 64 patients were under 18 years of age, 62 patients did not survive the first three months after HTx and 7 patients were retransplantations.

Results

During a median follow-up of 9.7 years, n = 121 (21.9%) of the patients developed ESRD. Of these, 22 received no RRT, 80 were treated with dialysis (46 with hemodialysis and 34 with peritoneal dialysis) and 19 underwent a kidney transplantation (KT). The ESRD-free survival at 1, 5 and 10 years follow-up was 96%, 84% and 58%, respectively. Patients with ESRD had a significantly worse overall survival compared to patients without (14.6 versus 12.1 years, p = 0.0001). KT was associated with the best median survival compared with patients treated with dialysis alone or those who received no RRT: 16.4 versus 10.4 versus 9.5 years, respectively.

Conclusion

ESRD is a frequent complication after HTx and is associated with statistically significant and clinically relevant worse overall survival. In our population, KT is the best therapeutic option for HTx patients who develop ESRD.