Value of Renal Histology in Predicting Cardiorenal Outcomes in Heart Transplant–listed Patients
Background. Cardiorenal syndrome (CRS) contributes significantly to morbidity and mortality in patients requiring mechanical circulatory support and transplantation. There are no validated markers to predict major adverse kidney events (MAKEs), for which simultaneous heart-kidney transplant (SHKT) c...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2023-01-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001424 |
| _version_ | 1797947109743263744 |
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| author | Sumita Barua, FRACP Tao Yang, MBBS, MSc, PhD, FRCPA Sean Conte, BA, MBBS Christopher Bragg, BSc Jacob Sevastos, BSc (Med), PhD, FRACP Peter S. Macdonald, MBBS, FRACP, PhD, MD, FCSANZ Kavitha Muthiah, MBChB, PhD, FRACP, FCSANZ Christopher S. Hayward, BMedSc, MD, FRACP, FCSANZ |
| author_facet | Sumita Barua, FRACP Tao Yang, MBBS, MSc, PhD, FRCPA Sean Conte, BA, MBBS Christopher Bragg, BSc Jacob Sevastos, BSc (Med), PhD, FRACP Peter S. Macdonald, MBBS, FRACP, PhD, MD, FCSANZ Kavitha Muthiah, MBChB, PhD, FRACP, FCSANZ Christopher S. Hayward, BMedSc, MD, FRACP, FCSANZ |
| author_sort | Sumita Barua, FRACP |
| collection | DOAJ |
| description | Background. Cardiorenal syndrome (CRS) contributes significantly to morbidity and mortality in patients requiring mechanical circulatory support and transplantation. There are no validated markers to predict major adverse kidney events (MAKEs), for which simultaneous heart-kidney transplant (SHKT) could offer improved survival. We evaluate renal histology in predicting MAKEs in transplant-listed patients.
Methods. We identified 18 patients with renal histology consistent with CRS from 655 consecutive heart transplant-listed patients between 2010 and 2019. Biopsies were analyzed for glomerular, tubular, interstitial, and arteriolar changes tallied to give a biopsy chronicity score. The primary outcome, MAKE, was a composite of death, need for renal replacement therapy (RRT), or estimated glomerular filtration rate decline >50%. These were evaluated at 2 time points: before and following the transplant. Secondary outcomes included the individual components of the composite outcomes and the need for short-term RRT following the transplant.
Results. The mean age was 52.3 y, 22% were female. Five patients did not survive to transplant. One patient underwent successful SHKT. MAKE occurred in 8 of 18 before the transplant and in 8 of 13 following the transplant. Neither outcome was predicted by baseline biochemistry. The biopsy chronicity score was significantly higher in patients with MAKE before transplant (4.3 versus 1.7, P = 0.024) and numerically higher in patients requiring short-term RRT following transplant (3.2 versus 0.7, P = 0.075). Contrary to limited previous literature, interstitial fibrosis did not predict any outcome, whereas tubular atrophy and arteriosclerosis were associated with MAKE before transplant.
Conclusions. A higher biopsy chronicity score was associated with adverse kidney endpoints, raising its potential utility over standard biochemistry in considering SHKT referral. |
| first_indexed | 2024-04-10T21:21:34Z |
| format | Article |
| id | doaj.art-4190e414d9a0449a8f6e21bc586b2fe5 |
| institution | Directory Open Access Journal |
| issn | 2373-8731 |
| language | English |
| last_indexed | 2024-04-10T21:21:34Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj.art-4190e414d9a0449a8f6e21bc586b2fe52023-01-20T02:41:41ZengWolters KluwerTransplantation Direct2373-87312023-01-0191e142410.1097/TXD.0000000000001424202301000-00009Value of Renal Histology in Predicting Cardiorenal Outcomes in Heart Transplant–listed PatientsSumita Barua, FRACP0Tao Yang, MBBS, MSc, PhD, FRCPA1Sean Conte, BA, MBBS2Christopher Bragg, BSc3Jacob Sevastos, BSc (Med), PhD, FRACP4Peter S. Macdonald, MBBS, FRACP, PhD, MD, FCSANZ5Kavitha Muthiah, MBChB, PhD, FRACP, FCSANZ6Christopher S. Hayward, BMedSc, MD, FRACP, FCSANZ71 Heart and Lung Transplant Unit, St Vincent’s Hospital Sydney, Darlinghurst, NSW, Australia.4 SydPath, St Vincent’s Hospital Sydney, Darlinghurst, NSW, Australia.1 Heart and Lung Transplant Unit, St Vincent’s Hospital Sydney, Darlinghurst, NSW, Australia.1 Heart and Lung Transplant Unit, St Vincent’s Hospital Sydney, Darlinghurst, NSW, Australia.2 School of Medicine, University of New South Wales, Kensington, NSW, Australia.1 Heart and Lung Transplant Unit, St Vincent’s Hospital Sydney, Darlinghurst, NSW, Australia.1 Heart and Lung Transplant Unit, St Vincent’s Hospital Sydney, Darlinghurst, NSW, Australia.1 Heart and Lung Transplant Unit, St Vincent’s Hospital Sydney, Darlinghurst, NSW, Australia.Background. Cardiorenal syndrome (CRS) contributes significantly to morbidity and mortality in patients requiring mechanical circulatory support and transplantation. There are no validated markers to predict major adverse kidney events (MAKEs), for which simultaneous heart-kidney transplant (SHKT) could offer improved survival. We evaluate renal histology in predicting MAKEs in transplant-listed patients. Methods. We identified 18 patients with renal histology consistent with CRS from 655 consecutive heart transplant-listed patients between 2010 and 2019. Biopsies were analyzed for glomerular, tubular, interstitial, and arteriolar changes tallied to give a biopsy chronicity score. The primary outcome, MAKE, was a composite of death, need for renal replacement therapy (RRT), or estimated glomerular filtration rate decline >50%. These were evaluated at 2 time points: before and following the transplant. Secondary outcomes included the individual components of the composite outcomes and the need for short-term RRT following the transplant. Results. The mean age was 52.3 y, 22% were female. Five patients did not survive to transplant. One patient underwent successful SHKT. MAKE occurred in 8 of 18 before the transplant and in 8 of 13 following the transplant. Neither outcome was predicted by baseline biochemistry. The biopsy chronicity score was significantly higher in patients with MAKE before transplant (4.3 versus 1.7, P = 0.024) and numerically higher in patients requiring short-term RRT following transplant (3.2 versus 0.7, P = 0.075). Contrary to limited previous literature, interstitial fibrosis did not predict any outcome, whereas tubular atrophy and arteriosclerosis were associated with MAKE before transplant. Conclusions. A higher biopsy chronicity score was associated with adverse kidney endpoints, raising its potential utility over standard biochemistry in considering SHKT referral.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001424 |
| spellingShingle | Sumita Barua, FRACP Tao Yang, MBBS, MSc, PhD, FRCPA Sean Conte, BA, MBBS Christopher Bragg, BSc Jacob Sevastos, BSc (Med), PhD, FRACP Peter S. Macdonald, MBBS, FRACP, PhD, MD, FCSANZ Kavitha Muthiah, MBChB, PhD, FRACP, FCSANZ Christopher S. Hayward, BMedSc, MD, FRACP, FCSANZ Value of Renal Histology in Predicting Cardiorenal Outcomes in Heart Transplant–listed Patients Transplantation Direct |
| title | Value of Renal Histology in Predicting Cardiorenal Outcomes in Heart Transplant–listed Patients |
| title_full | Value of Renal Histology in Predicting Cardiorenal Outcomes in Heart Transplant–listed Patients |
| title_fullStr | Value of Renal Histology in Predicting Cardiorenal Outcomes in Heart Transplant–listed Patients |
| title_full_unstemmed | Value of Renal Histology in Predicting Cardiorenal Outcomes in Heart Transplant–listed Patients |
| title_short | Value of Renal Histology in Predicting Cardiorenal Outcomes in Heart Transplant–listed Patients |
| title_sort | value of renal histology in predicting cardiorenal outcomes in heart transplant listed patients |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001424 |
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