Transcatheter Aortic Valve Replacement Outcomes in Patients With Native vs Transplanted Kidneys: Data From an International Multicenter Registry

Guy Witberg, Jasmin Shamekhi, Nicolas M. Van Mieghem, Adolfo Ferrero-Guadagnoli, Lars Soendergaard, Danny Dvir, Azeem Latib, Luca Testa, Mayra Guerrero, Nicolo Piazza, Sabine Bleiziffer, John G. Webb, Israel Barbash, Ariel Finkelstein, Raj Makkar, Darren Mylotte, Jan Malte Sinning, Nahid El Faquir, Francesco Masiano, Ole De BackerAntoinette Birs, Giuseppe Lanzillo, Francesco Bedogni, Omer Iftikhar, Michele Pighi, Marcus Andre Deutsch, Adrian Attinger-Toller, Elad Maor, Zach Rozenbaum, Sung Han Yoon, Antoinette Neylon, Ran Kornowski

Research output: Contribution to journalArticle

Abstract

Background: Chronic kidney disease (CKD) has a negative impact on outcomes after transcatheter aortic valve replacement (TAVR). Data on outcomes in renal transplant recipients (RTRs) undergoing TAVR are scarce. We compared the outcomes in RTRs undergoing TAVR with matched patients who have native kidneys and similar kidney function. Methods: This retrospective cohort study used data from 16 TAVR centres (13,941 patients). The study cohort included 216 patients (72 RTRs and 144 matched controls). Results: The mean estimated glomerular filtration rate (eGFR) was 39.2 ± 23.6 vs 44.5 ± 23.6 mL/min for RTRs and control patients (P = 0.149), with a similar CKD stage distribution. After TAVR, the eGFR declined among RTRs but remained stable for up to 1 year in controls (P = 0.021). Long-term hemodialysis was required in 19 (26.4%) RTRs and 20 (13.8%) controls (hazard ratio [HR] = 2.09 95% confidence interval [CI], 1.03-3.86; P = 0.039) and was most often initiated during the periprocedural period (14 RTRs vs 16 controls; P = 0.039). After a median follow-up of 2.3 years, risk of death (29.2% vs 31.9%) and death/hemodialysis (40.3% vs 36.8%) was similar between the groups. The contrast volume/eGFR ratio was the strongest predictor of hemodialysis initiation (odds ratio [OR] = 1.64; 95% CI, 1.36-1.97 per 1 unit increase; P < 0.001), with a greater effect among RTRs than controls (P for interaction = 0.022). Conclusion: s: TAVR appears safe in RTRs with mortality rates similar to matched patients with native kidneys. However, RTRs carry an increased risk of progressive renal impairment and need for hemodialysis initiation after TAVR. Our data highlight the importance of minimizing contrast load during TAVR, particularly in RTRs.

Original languageEnglish
Pages (from-to)1114-1123
Number of pages10
JournalCanadian Journal of Cardiology
Volume35
Issue number9
DOIs
Publication statusPublished - Sep 2019

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Witberg, G., Shamekhi, J., Van Mieghem, N. M., Ferrero-Guadagnoli, A., Soendergaard, L., Dvir, D., Latib, A., Testa, L., Guerrero, M., Piazza, N., Bleiziffer, S., Webb, J. G., Barbash, I., Finkelstein, A., Makkar, R., Mylotte, D., Sinning, J. M., El Faquir, N., Masiano, F., ... Kornowski, R. (2019). Transcatheter Aortic Valve Replacement Outcomes in Patients With Native vs Transplanted Kidneys: Data From an International Multicenter Registry. Canadian Journal of Cardiology, 35(9), 1114-1123. https://doi.org/10.1016/j.cjca.2019.01.003