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.
Résumé
Introduction
La néphropathie chronique a un effet négatif sur les résultats du remplacement valvulaire
aortique par cathéter (RVAC). Les données sur les résultats des receveurs d’une greffe
du rein qui se prêtent à un RVAC sont rares. Nous avons comparé les résultats de receveurs
d’une greffe du rein qui se prêtent à un RVAC et de patients appariés ayant encore
leurs propres reins et dont la capacité fonctionnelle rénale était similaire.
Méthodologie
Cette étude de cohorte rétrospective a utilisé les données de 16 centres de RVAC (13
941 patients). La cohorte de l’étude comprenait 216 patients (72 receveurs d’une greffe
du rein et 144 témoins appariés).
Résultats
Le taux de filtration glomérulaire estimé (TFGe) moyen a été de 39,2 ± 23,6 ml/min
chez les receveurs d’une greffe du rein et de 44,5 ± 23,6 ml/min chez les témoins
(p = 0,149), la distribution des stades de la néphropathie chronique étant similaire
entre les groupes. Après le RVAC, le TFGe a diminué chez les receveurs d’une greffe
du rein, mais est resté stable pendant une période maximale de 1 an chez les témoins
(p = 0,021). Dix-neuf receveurs d’une greffe du rein (26,4 %) et 20 témoins (13,8 %)
ont nécessité une hémodialyse à long terme (rapport des risques instantanés : 2,09;
intervalle de confiance [IC] à 95 % : 1,03 – 3,86; p = 0,039); l’hémodialyse a été le plus souvent entreprise durant la période péri-procédurale
(14 receveurs d’une greffe du rein et 16 témoins; p = 0,039). Après un suivi médian de 2,3 ans, le risque de décès (29,2 % vs 31,9 %)
et de décès/hémodialyse (40,3 % vs 36,8 %) était similaire entre les groupes. Le rapport
volume d’agent de contraste/TFGe a été le facteur de prédiction le plus robuste de
l’instauration de l’hémodialyse (risque relatif approché : 1,64; IC à 95 % : 1,36
– 1,97 par palier d’augmentation de 1 unité; p < 0,001), l’effet étant plus important chez les receveurs d’une greffe du rein que
chez les témoins (p pour l’interaction = 0,022).
Conclusions
Il semble que le RVAC soit sûr chez les receveurs d’une greffe du rein, les taux de
mortalité étant semblables à ceux observés chez les patients appariés possédant encore
leurs propres reins. Les receveurs d’une greffe du rein sont néanmoins exposés à un
plus grand risque d’insuffisance rénale progressive et d’hémodialyse après le RVAC.
Nos données soulignent l’importance de réduire au maximum le volume d’agent de contraste
utilisé pendant le RVAC, particulièrement chez les receveurs d’une greffe du rein.
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Article info
Publication history
Published online: January 18, 2019
Accepted:
January 10,
2019
Received:
October 14,
2018
Footnotes
See editorial by Lam and James, pages 1085–1087 of this issue.
See page 1122 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
