The trajectory of renal function following mechanical circulatory support and subsequent heart transplantation

Abstract

Aim Patients with advanced heart failure (HF) frequently suffer from renal insufficiency. The impact of durable mechanical circulatory support (MCS) and subsequent heart transplantation (HTx) on kidney function is not well described. Methods and results We studied patients with advanced HF who received durable MCS as bridge to transplantation (BTT) and underwent subsequent HTx at our centre between 1996 and 2018. Glomerular filtration rate (GFR) was measured by 51Cr‐EDTA or iohexol clearance during heart failure work‐up; 3–6 months after MCS; and 1 year after HTx. Chronic kidney disease (CKD) was classified according to KDIGO criteria based on estimated GFR. A total of 88 patients (46 ± 15 years, 84% male) were included, 63% with non‐ischaemic heart disease. The median duration of MCS‐treatment was 172 (IQR 116–311) days, and 81 subjects were alive 1 year after HTx. Measured GFR increased from 54 ± 19 during HF work‐up to 60 ± 16 mL/min/1.73 m2 after MCS (P < 0.001) and displayed a slight but nonsignificant decrease to 57 ± 22 mL/min/1.73 m2 1 year after HTx (P = 0.38). The trajectory of measured GFR did not differ between pulsatile and continuous flow (CF) pumps. Among patients 35–49 years and those who were treated in the most recent era (2012–2018), measured GFR increased following MCS implantation and subsequent HTx. Estimated GFR displayed a similar course as did measured GFR. Conclusions In patients with advanced heart failure, measured GFR improved after MCS with no difference between pulsatile and CF‐pumps. The total study group showed no further increase in GFR following HTx, but in certain subgroups, including patients aged 35–54 years and those treated during the latest era (2012–2018), renal function appeared to improve after transplant.

Heart transplantation in patients bridged with mechanical circulatory support: outcome comparison with matched controls

“…Interestingly, the renal function in our patients remained stable during post HTx follow‐up, and did not worsen over time as previously reported 25,26 . This is in line with a recent publication from our centre showing a stabilization of renal function after HTx during the latest era (2012–2018) 27 . Notably, a higher proportion of control patients was treated with everolimus combined with a low dose calcineurin inhibitors as a renal sparing protocol.…”

“…25,26 This is in line with a recent publication from our centre showing a stabilization of renal function after HTx during the latest era (2012-2018). 27 Notably, a higher proportion of control patients was treated with everolimus combined with a low dose calcineurin inhibitors as a renal sparing protocol. We speculate that a better haemodynamic stability among MCS patients may reduce their need for everolimus as a part of a post-HTx renal sparing strategy.…”

Kidney health and function with left ventricular assist devices

“…A limitation of reliance on eGFR is the potential confounding of eGFR by body composition and fluid changes. A recently reported study performed in 88 persons measured GFR before LVAD implantation, 3 to 6 months after LVAD implantation, and then 1 year following heart transplantation [32 ▪ ]. This found that in the subset of those implanted in more recent years, measured GFR increased following LVAD implantation and heart transplantation.…”

miR‐8485 alleviates the injury of cardiomyocytes through TP53INP1

“…Chronic heart failure (CHF) is a pathological syndrome in which the circulating blood volume cannot meet the systemic metabolic needs due to impaired filling function and ejection function, and it is the end stage of various heart disease. [1] CHF is caused by myocardial infarction, cardiomyopathy, hemodynamic overload, inflammation, leading to changes in myocardial structure and function. [2,3] It is vital to clarify the pathogenesis of CHF, and improve the diagnosis and treatment of CHF.…”