Comparative analysis of perioperative renal function in patients undergoing heart transplantation and left ventricular assist device implantation: a multicenter retrospective study.

Background: Renal function is a crucial factor affecting the prognosis of patients with end-stage heart failure (HF). The differential impacts of heart transplantation and left ventricular assist device (LVAD) implantation on renal function are unclear. Therefore, we compared the perioperative renal function changes in patients who underwent heart transplantation with that of patients who underwent LVAD implantation.

Methods: This study included 77 patients who underwent heart transplantation and 59 patients who underwent LVAD implantation at five hospitals between January 2019 and December 2023. These patients were divided into two groups based on surgery type: heart transplantation or LVAD implantation. The estimated glomerular filtration rates (eGFRs) before surgery and on postoperative days (PODs) 1, 7, and 30 were compared. A subgroup analysis was conducted for patients with preoperative renal dysfunction, and paired-samples -tests were used to compare renal function changes before and one month after surgery.

Results: Patients in the LVAD group were older (56.4 44.4 years, P<0.001) and had lower preoperative eGFRs (72.5 91.3 mL/min/1.73 m, P=0.001) than patients in the heart transplantation group did. On POD 1 and POD 7, the LVAD group continued to have a lower eGFR than the heart transplantation group. The baseline eGFRs were not significantly different (63.3 60.4 mL/min/1.73 m, P=0.44) in patients with preoperative renal dysfunction (eGFR <90 mL/min/1.73 m). However, on PODs 1, 7, and 30, the eGFR in the LVAD group was significantly greater than that in the heart transplantation group. By POD 30, renal function in the LVAD group had recovered to near-normal levels (60.4-87.6 mL/min/1.73 m), whereas in the heart transplantation group, the eGFR remained close to the preoperative level (63.3-63.4 mL/min/1.73 m). In the LVAD group, the eGFR significantly increased on POD 30, with 84.7% (50/59) of the LVAD patients showing varying degrees of improvement in renal function. In the heart transplantation group, patients' eGFRs on POD 30 were comparable to their preoperative values, with more than half of them showing a decreased eGFR. Among the patients with preoperative renal dysfunction, 10 without a history of preoperative continuous renal replacement therapy (CRRT) underwent postoperative CRRT in the heart transplantation group; nine of them died within three months of transplantation. In the LVAD group, three patients without preoperative CRRT support required CRRT postoperatively, with one case of early mortality.

Conclusions: For patients with end-stage HF and concurrent renal dysfunction, compared to heart transplantation, LVAD implantation with this new device resulted in significantly improved renal function. With no malfunctions, the device operated in a safe and effective manner and was successfully managed to improve renal function.