Impact Of Baseline Renal Function On Waitlist Outcomes In Patients Supported With Impella As A Bridge To Transplant

• Published in: Journal of cardiac failure Vol. 29; no. 4; pp. 580 - 581
• Main Authors: Steinberg, Rebecca, Okoh, Alexis, Patel, Krishan, Wang, Jeffrey, Patel, Pujan, Gangavelli, Apoorva, Gupta, Divya, Daneshmand, Mani, Morris, Alanna
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2023
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2022.10.087

Acute kidney injury is common during support with microaxial percutaneous left ventricular assist devices (pLVAD) for cardiogenic shock. The effect of baseline renal function on outcomes in subjects listed for heart transplantation (HT) supported with pLVAD remains unknown. We investigated the association between baseline renal function and waitlist outcomes in listed patients supported with an Impella. We utilized de-identified data from the United Network for Organ Sharing database on adults listed for HT who were supported with an Impella 5.0 or Impella 5.5 (Abiomed, Denver, MA) for cardiogenic shock between October 2018 and March 2020. Patients were stratified into three groups based on their estimated glomerular filtration rate (eGFR) (< 30 vs. 30-60 vs. > 60 mL/min/1.73m2) at listing. Paired t-tests were used to assess the change in renal function from listing to the time of transplant for all 3 groups. The competing risks of waitlist mortality or transplantation were examined using the Fine-Grey sub-distribution hazard model. Of 272 patients (mean age 54±13) supported with an Impella while listed for HT during the study period, 37 (13.6%) had an eGFR < 30, 101 (37.1%) had an eGFR 30-60, and 134 (49.3%) had an eGFR > 60 at the time of listing. Duration of support was comparable between all groups (14 vs. 13 vs. 12 days; p=0.209). Median waitlist time was 15 (IQR 7, 43) days, with no significant difference between groups. At the time of transplant, the changes in eGFR [GFR group; delta: p value] were [GFR < 30; +13.3; <0.001], [GFR 30-60; +9.9; <0.001] and [GFR > 60; -10.5; <0.001]. Baseline renal function [ref: eGFR > 60] was not associated with waitlist mortality [eGFR 30-60: hazard ratio (HR) 3.57; 95% confidence interval (CI) 0.73-17.50, eGFR < 30: HR 1.73; 95% CI 0.39-7.70] or transplantation [eGFR 30-60: HR 0.98; 95% CI 0.75-1.26, eGFR < 30: HR 1.08; 95% CI 0.75-1.26]. In patients listed for HT who supported with an Impella for cardiogenic shock, baseline renal function had no impact on waitlist outcomes. Between listing and transplant, a significant improvement in eGFR was seen in patients listed with severely reduced eGFR.