In-Hospital Mortality and Major Adverse Cardiovascular Events after Kidney Transplantation in the United States

Abstract

Background: Kidney transplantation (KT) is the treatment of choice for end-stage kidney disease. Cardiovascular disease is a major determinant of morbidity and mortality in patients with KT. Temporal trends in perioperative cardiovascular outcomes after KT are understudied, especially in light of an aging KT waitlist population. Methods: We performed a retrospective observational cohort study using the National Inpatient Sample for the years 2004–2013. All adult patients undergoing KT were identified using the appropriate International Classification of Diseases, 9th Revision, Clinical Modification codes. Demographic and hospital characteristics, discharge disposition, payer status, and major adverse cardiovascular events (MACEs) were summarized using summary statistics. Multivariate logistic regression was used to identify predictors of MACEs in the perioperative period of KT. Results: A total of 147,431 KTs were performed between 2004 and 2013. The mean age at KT went up from 48.1 to 51.8 years from 2004 to 2013. Medicare was the primary payer for 59.6% of the KTs. Overall average perioperative mortality was 0.5%, median length of stay was 5 days, and 6.5% of patients experienced an MACE, 78% of which were heart failures (HFs). Important predictors of perioperative MACEs were age ≥65 years (OR = 2.14), Medicare as primary payer (OR = 1.51), diabetes (OR = 1.46), recreational drug use (OR = 1.72), pulmonary circulation disorders (OR = 3.28), and malnutrition (OR = 1.91). Conclusion: Despite increases in age at the time of KT, the absolute risk of perioperative MACEs has remained stable from 2004 to 2013. HF is a major component of postoperative MACEs in KT. Malnutrition and pulmonary hypertension are major nontraditional predictors of perioperative MACE outcomes.

Impact of cardiovascular risk stratification strategies in kidney transplantation over time

“…Registry data from the USA [ 32 ] and Europe [ 33 ] point towards an ageing transplant recipient population. Single studies from the USA [ 34 ], Canada [ 35 ], Australia [ 36 ] and Europe [ 37 ] also report increasing recipient age. It is feasible that current evaluation strategies implemented in Austria promote the exclusion of ‘older and sicker’ ESRD patients from KT waiting list.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2019

“…Predictors of perioperative MACE were age �65 years (OR ¼ 2.14), Medicare as the primary payer (OR ¼ 1.51), diabetes (OR ¼ 1.46), recreational drug use (OR ¼ 1.72), pulmonary circulation disorders (OR ¼ 3.28), and malnutrition (OR ¼ 1.91). 44…”

“…For LDKT recipients, heart failure and diabetes were risk factors for poorer transplant survival. � Predictors of MACE: Goyal et al 44 This analysis of the NIS revealed predictors of MACE after KT to be age �65, Medicare as primary payer, diabetes, recreational drug use, pulmonary circulation disorders, and malnutrition.…”

Non-invasive cardiac stress studies may not offer significant benefit in pre-kidney transplant evaluation: A retrospective cohort study

“…There are very few randomized studies that have evaluated the benefit of coronary revascularization over standard medical therapy [ 18 ]. A recent study by Goyal et al [ 19 ] from the National Inpatient Sample in the US showed that rates of perioperative MACE after kidney transplantation remain low on an absolute level and the data suggest that post- operative MACE may be driven more by heart failure than acute coronary syndromes. Therefore, clinicians wrestle with the question of whether screening for occult ischemic heart disease is effective in preventing subsequent vascular events.…”