Lisa B VanWagner1,2,3, Samantha Montag2, Lihui Zhao2, Norrina B Allen2, Donald M Lloyd-Jones2,4, Arighno Das1, Anton I Skaro5, Samuel Hohmann6, John J Friedewald3,7, Josh Levitsky1,3. 1. Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. 2. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. 3. Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL. 4. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. 5. Division of General Surgery and Multi-Organ Transplant, Department of Surgery, University of Western Ontario Schulich School of Medicine and Dentistry, Ontario, Canada. 6. Center for Advanced Analytics, Vizient, Chicago, IL. 7. Division of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Abstract
BACKGROUND: In the general population, even mild renal disease is associated with increased cardiovascular (CV) complications. Whether this is true in liver transplant recipients (LTR) is unknown. METHODS: This was a retrospective cohort study of 671 LTR (2002-2012) from a large urban tertiary care center and 37 322 LTR using Vizient hospitalization data linked to the United Network for Organ Sharing. The 4-variable Modification of Diet in Renal Disease equation estimated glomerular filtration rate (eGFR). Outcomes were 1-year CV complications (death/hospitalization from myocardial infarction, heart failure, atrial fibrillation, cardiac arrest, pulmonary embolism, or stroke) and mortality. Latent mixture modeling identified trajectories in eGFR in the first liver transplantation (LT) year in the 671 patients. RESULTS: Mean (SD) eGFR was 72.1 (45.7) mL/min per 1.73 m. Six distinct eGFR trajectories were identified in the local cohort (n = 671): qualitatively normal-slow decrease (4% of cohort), normal-rapid decrease (4%), mild-stable (18%), mild-slow decrease (35%), moderate-stable (30%), and severe-stable (9%). In multivariable analyses adjusted for confounders and baseline eGFR, the greatest odds of 1-year CV complications were in the normal-rapid decrease group (odds ratio, 10.6; 95% confidence interval, 3.0-36.9). Among the national cohort, each 5-unit lower eGFR at LT was associated with a 2% and 5% higher hazard of all-cause and CV-mortality, respectively (P < 0.0001), independent of multiple confounders. CONCLUSIONS: Even mild renal disease at the time of LT is a risk factor for posttransplant all-cause and CV mortality. More rapid declines in eGFR soon after LT correlate with risk of adverse CV outcomes, highlighting the need to study whether early renal preservation interventions also reduce CV complications.
BACKGROUND: In the general population, even mild renal disease is associated with increased cardiovascular (CV) complications. Whether this is true in liver transplant recipients (LTR) is unknown. METHODS: This was a retrospective cohort study of 671 LTR (2002-2012) from a large urban tertiary care center and 37 322 LTR using Vizient hospitalization data linked to the United Network for Organ Sharing. The 4-variable Modification of Diet in Renal Disease equation estimated glomerular filtration rate (eGFR). Outcomes were 1-year CV complications (death/hospitalization from myocardial infarction, heart failure, atrial fibrillation, cardiac arrest, pulmonary embolism, or stroke) and mortality. Latent mixture modeling identified trajectories in eGFR in the first liver transplantation (LT) year in the 671 patients. RESULTS: Mean (SD) eGFR was 72.1 (45.7) mL/min per 1.73 m. Six distinct eGFR trajectories were identified in the local cohort (n = 671): qualitatively normal-slow decrease (4% of cohort), normal-rapid decrease (4%), mild-stable (18%), mild-slow decrease (35%), moderate-stable (30%), and severe-stable (9%). In multivariable analyses adjusted for confounders and baseline eGFR, the greatest odds of 1-year CV complications were in the normal-rapid decrease group (odds ratio, 10.6; 95% confidence interval, 3.0-36.9). Among the national cohort, each 5-unit lower eGFR at LT was associated with a 2% and 5% higher hazard of all-cause and CV-mortality, respectively (P < 0.0001), independent of multiple confounders. CONCLUSIONS: Even mild renal disease at the time of LT is a risk factor for posttransplant all-cause and CV mortality. More rapid declines in eGFR soon after LT correlate with risk of adverse CV outcomes, highlighting the need to study whether early renal preservation interventions also reduce CV complications.
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Authors: Lisa B VanWagner; Jane L Holl; Samantha Montag; Dyanna Gregory; Sean Connolly; Megan Kosirog; Patrick Campbell; Stewart Pine; Amna Daud; Dan Finn; Daniela Ladner; Anton I Skaro; Josh Levitsky; Donald M Lloyd-Jones Journal: Am J Transplant Date: 2019-12-09 Impact factor: 8.086
Authors: Deok-Gie Kim; Shin Hwang; Jong Man Kim; Je Ho Ryu; Young Kyoung You; Donglak Choi; Bong-Wan Kim; Dong-Sik Kim; Yang Won Nah; Tae-Seok Kim; Jai Young Cho; Geun Hong; Jae Do Yang; Jaryung Han; Suk-Won Suh; Kwan Woo Kim; Yun Kyung Jung; Ju Ik Moon; Jun Young Lee; Sung Hwa Kim; Jae Geun Lee; Myoung Soo Kim; Kwang-Woong Lee; Dong Jin Joo Journal: J Clin Med Date: 2022-07-20 Impact factor: 4.964