Longitudinal changes in kidney function following heart transplantation: Stanford experience

Abstract

Many heart transplant recipients experience declining kidney function following transplantation. We aimed to quantify change in kidney function in heart transplant recipients stratified by pre-transplant kidney function. A total of 230 adult heart transplant recipients between May 1, 2008, and December 31, 2014, were evaluated for up to 5 years post-transplant (median 1 year). Using 19 398 total estimated glomerular filtration rate (eGFR) assessments, we evaluated trends in eGFR in recipients with normal/near-normal (eGFR ≥45 mL/min/1.73 m² ) vs impaired (eGFR <45 mL/min/1.73 m² ) kidney function and the likelihood of reaching an eGFR of 20 mL/min/1.73 m² after heart transplant. Baseline characteristics were similar. Immediately following heart transplant, the impaired pre-transplant kidney function group showed a mean eGFR gain of 9.5 mL/min/1.73 m² (n = 193) vs a mean decline of 4.9 mL/min/1.73 m² (n = 37) in the normal/near-normal group. Subsequent rates of eGFR decline were 2.2 mL/min/1.73 m² /y vs 2.9 mL/min/1.73 m² /y, respectively. The probability of reaching an eGFR of 20 mL/min/1.73 m² or less at 1, 5, and 10 years following heart transplant was 1%, 4%, and 30% in the impaired group, and <1%, <1%, and 10% in the normal/near-normal group. Estimates of expected recovery in kidney function and its decline over time will help inform decision making about kidney care after heart transplantation.