Perioperative renal function in patients undergoing heart transplantation versus left ventricular assist device implantation: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WEN Mingxiu , ZHAO Shuanglei , LIU Zhou , HU Yi , LI Qianxian , HAN Jie , ZHANG Hongjia ,  GONG Ming

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P. R. China;

Corresponding author：

GONG Ming, Email: gongming@mail.ccmu.edu.cn

Keywords：

Left ventricular assist device; heart transplantation; renal function; end-stage heart failure

DOI：

10.7507/1007-4848.202402033

Video：

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Objective To compare the perioperative renal function changes in patients undergoing heart transplantation (HT) and left ventricular assist device (LVAD) implantation. Methods Patients with end-stage heart failure who underwent surgical treatment at Beijing Anzhen Hospital, Capital Medical University from January 2019 to April 2024 were included. According to the surgical method, patients were divided into a HT group and a LVAD group, and the estimated glomerular filtration rate (eGFR) of patients before surgery and postoperative 1, 7, 30, 60 days was compared between the two groups. The patients with preoperative renal dysfunction were subdivided into subgroups for comparison of eGFR changes before surgery and 30 days after surgery between the two groups. Results A total of 112 patients were enrolled. There were 78 patients in the HT group, including 61 males and 17 females, aged (44.42±18.51) years. There were 34 patients in the LVAD group, including 30 males and 4 females, aged (54.94±11.37) years. Compared with the HT group, the average age of patients in the LVAD group was greater (P<0.001), body mass index was higher (P=0.008), preoperative eGFR was lower (P=0.009), and the proportions of smokers (P=0.017), alcohol drinkers (P=0.041), and diabetes mellitus (P=0.028) patients were higher. Among patients with preoperative renal dysfunction [eGFR<90 mL/(min·1.73 m²)], compared with the HT group, the postoperative eGFR of the LVAD group was significantly higher than that of the HT group, and it was significantly increased compared with that before surgery; the postoperative eGFR of the HT group was comparable to that before surgery, and more than half of the patients had a lower eGFR than before surgery. Among patients with preoperative renal dysfunction, 11 patients in the HT group received continuous renal replacement therapy, and 8 died early; 2 patients in the LVAD group received continuous renal replacement therapy, and 1 died early. Conclusion For end-stage heart failure patients with combined renal dysfunction, compared with HT, LVAD implantation enables patients to obtain better renal function benefits.

Citation： WEN Mingxiu, ZHAO Shuanglei, LIU Zhou, HU Yi, LI Qianxian, HAN Jie, ZHANG Hongjia, GONG Ming. Perioperative renal function in patients undergoing heart transplantation versus left ventricular assist device implantation: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(11): 1594-1598. doi: 10.7507/1007-4848.202402033 Copy

1.	Bragazzi NL, Zhong W, Shu J, et al. Burden of heart failure and underlying causes in 195 countries and territories from 1990 to 2017. Eur J Prev Cardiol, 2021, 28(15): 1682-1690.
2.	Varshney AS, DeFilippis EM, Cowger JA, et al. Trends and outcomes of left ventricular assist device therapy: JACC Focus Seminar. J Am Coll Cardiol, 2022, 79(11): 1092-1107.
3.	Yuzefpolskaya M, Schroeder SE, Houston BA, et al. The Society of Thoracic Surgeons Intermacs 2022 annual report: Focus on the 2018 heart transplant allocation system. Ann Thorac Surg, 2023, 115(2): 311-327.
4.	Mehra MR, Goldstein DJ, Uriel N, et al. Two-year outcomes with a magnetically levitated cardiac pump in heart failure. N Engl J Med, 2018, 378(15): 1386-1395.
5.	McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J, 2021, 42(36): 3599-3726.
6.	Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 145(18): e876-e894.
7.	Naesens M, Kuypers DR, Sarwal M. Calcineurin inhibitor nephrotoxicity. Clin J Am Soc Nephrol, 2009, 4(2): 481-508.
8.	Yessayan L, Shafiq A, Peterson E, et al. Race, calcineurin inhibitor exposure, and renal function after solid organ transplantation. Transplant Proc, 2015, 47(10): 2968-2972.
9.	Hasin T, Topilsky Y, Schirger JA, et al. Changes in renal function after implantation of continuous-flow left ventricular assist devices. J Am Coll Cardiol, 2012, 59(1): 26-36.
10.	Patel AM, Adeseun GA, Ahmed I, et al. Renal failure in patients with left ventricular assist devices. Clin J Am Soc Nephrol, 2013, 8(3): 484-496.
11.	Saeed D, Feldman D, Banayosy AE, et al. The 2023 International Society for Heart and Lung Transplantation guidelines for mechanical circulatory support: A 10-year update. J Heart Lung Transplant, 2023, 42(7): e1-e222.
12.	Daimee UA, Wang M, Papernov A, et al. Renal function changes following left ventricular assist device implantation. Am J Cardiol, 2017, 120(12): 2213-2220.
13.	Sandner SE, Zimpfer D, Zrunek P, et al. Renal function and outcome after continuous flow left ventricular assist device implantation. Ann Thorac Surg, 2009, 87(4): 1072-1078.
14.	Haglund NA, Feurer ID, Dwyer JP, et al. Does renal dysfunction and method of bridging support influence heart transplant graft survival? Ann Thorac Surg, 2014, 98(3): 835-841.
15.	Hu J, Xu X, Zhang K, et al. Comparison of estimated glomerular filtration rates in Chinese patients with chronic kidney disease among serum creatinine-, cystatin-C- and creatinine-cystatin-C-based equations: A retrospective cross-sectional study. Clin Chim Acta, 2020, 505: 34-42.
16.	Arshad A, Kew EP, Lim S. Comparison of renal outcomes in patients with left ventricular assist device and heart transplantation. Transplant Proc, 2019, 51(10): 3395-3398.
17.	O'Sullivan ED, Hughes J, Ferenbach DA. Renal aging: Causes and consequences. J Am Soc Nephrol, 2017, 28(2): 407-420.
18.	Williams D, Haragsim L. Calcineurin nephrotoxicity. Adv Chronic Kidney Dis, 2006, 13(1): 47-55.
19.	Ross DW, Stevens GR, Wanchoo R, et al. Left ventricular assist devices and the kidney. Clin J Am Soc Nephrol, 2018, 13(2): 348-355.
20.	Puhlman M. Continuous-flow left ventricular assist device and the right ventricle. AACN Adv Crit Care, 2012, 23(1): 86-90.

1. Bragazzi NL, Zhong W, Shu J, et al. Burden of heart failure and underlying causes in 195 countries and territories from 1990 to 2017. Eur J Prev Cardiol, 2021, 28(15): 1682-1690.
2. Varshney AS, DeFilippis EM, Cowger JA, et al. Trends and outcomes of left ventricular assist device therapy: JACC Focus Seminar. J Am Coll Cardiol, 2022, 79(11): 1092-1107.
3. Yuzefpolskaya M, Schroeder SE, Houston BA, et al. The Society of Thoracic Surgeons Intermacs 2022 annual report: Focus on the 2018 heart transplant allocation system. Ann Thorac Surg, 2023, 115(2): 311-327.
4. Mehra MR, Goldstein DJ, Uriel N, et al. Two-year outcomes with a magnetically levitated cardiac pump in heart failure. N Engl J Med, 2018, 378(15): 1386-1395.
5. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J, 2021, 42(36): 3599-3726.
6. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 145(18): e876-e894.
7. Naesens M, Kuypers DR, Sarwal M. Calcineurin inhibitor nephrotoxicity. Clin J Am Soc Nephrol, 2009, 4(2): 481-508.
8. Yessayan L, Shafiq A, Peterson E, et al. Race, calcineurin inhibitor exposure, and renal function after solid organ transplantation. Transplant Proc, 2015, 47(10): 2968-2972.
9. Hasin T, Topilsky Y, Schirger JA, et al. Changes in renal function after implantation of continuous-flow left ventricular assist devices. J Am Coll Cardiol, 2012, 59(1): 26-36.
10. Patel AM, Adeseun GA, Ahmed I, et al. Renal failure in patients with left ventricular assist devices. Clin J Am Soc Nephrol, 2013, 8(3): 484-496.
11. Saeed D, Feldman D, Banayosy AE, et al. The 2023 International Society for Heart and Lung Transplantation guidelines for mechanical circulatory support: A 10-year update. J Heart Lung Transplant, 2023, 42(7): e1-e222.
12. Daimee UA, Wang M, Papernov A, et al. Renal function changes following left ventricular assist device implantation. Am J Cardiol, 2017, 120(12): 2213-2220.
13. Sandner SE, Zimpfer D, Zrunek P, et al. Renal function and outcome after continuous flow left ventricular assist device implantation. Ann Thorac Surg, 2009, 87(4): 1072-1078.
14. Haglund NA, Feurer ID, Dwyer JP, et al. Does renal dysfunction and method of bridging support influence heart transplant graft survival? Ann Thorac Surg, 2014, 98(3): 835-841.
15. Hu J, Xu X, Zhang K, et al. Comparison of estimated glomerular filtration rates in Chinese patients with chronic kidney disease among serum creatinine-, cystatin-C- and creatinine-cystatin-C-based equations: A retrospective cross-sectional study. Clin Chim Acta, 2020, 505: 34-42.
16. Arshad A, Kew EP, Lim S. Comparison of renal outcomes in patients with left ventricular assist device and heart transplantation. Transplant Proc, 2019, 51(10): 3395-3398.
17. O'Sullivan ED, Hughes J, Ferenbach DA. Renal aging: Causes and consequences. J Am Soc Nephrol, 2017, 28(2): 407-420.
18. Williams D, Haragsim L. Calcineurin nephrotoxicity. Adv Chronic Kidney Dis, 2006, 13(1): 47-55.
19. Ross DW, Stevens GR, Wanchoo R, et al. Left ventricular assist devices and the kidney. Clin J Am Soc Nephrol, 2018, 13(2): 348-355.
20. Puhlman M. Continuous-flow left ventricular assist device and the right ventricle. AACN Adv Crit Care, 2012, 23(1): 86-90.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Perioperative renal function in patients undergoing heart transplantation versus left ventricular assist device implantation: A retrospective cohort study

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