Left Ventricular Ejection Fraction and Previous Cardiac Revascularization: Impact on Patient Survival, Graft Survival, and Complications in Kidney Transplant Recipients.

Background: Kidney transplant physicians believe that the cardiac status of kidney transplant recipients influences posttransplant outcomes. However, the Scientific Registry of Transplant Recipients (SRTR) does not include cardiac variables in its risk-adjustment model, raising the question of whether it fairly risk adjusts recipients.

Methods: This study conducted a retrospective analysis of the prospectively collected National Surgical Quality Improvement Program Transplant database to assess the impacts of pretransplant cardiac revascularization and left ventricular ejection fraction (LVEF) <55% on posttransplant outcomes in deceased donor renal transplantation. Recipients from 2017 to 2019 were stratified into those with versus without prior revascularization and those with LVEF <55% versus LVEF ≥55%. Primary outcomes included differences in 1-y patient and graft survival. Secondary outcomes included postoperative complications. An a priori-specified multivariable Cox-proportional hazards model including existing SRTR variables assessed the independent effect of prior revascularization on patient and graft survival.

Results: A total of 2377 recipients were included: 13.3% had prior cardiac revascularization and 11.2% had LVEF <55%. Previous revascularization was significantly associated with an increased risk of deep surgical site infection (3.8% versus 1.1%,  = 0.001), delayed graft function (39.2% versus 28.3%,  < 0.001), myocardial infarction (4.4% versus 0.8%,  < 0.001), longer length of stay (6.57 versus 5.54 d,  = 0.001), and more readmissions (32.9% versus 23.1%,  < 0.001). In univariable analysis, previous revascularization was associated with death (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.11-5.1;  = 0.03) but not graft loss (HR, 1.3; 95% CI, 0.54-3.1;  = 0.55). LVEF <55% was only associated with a higher rate of sepsis (4.3% versus 1.7%,  = 0.011). After adjusting for SRTR variables (age, diabetes, peripheral vascular disease), previous revascularization was not independently associated with death (HR, 1.33; 95% CI, 0.57-3.1;  = 0.50).

Conclusions: Previous cardiac revascularization is associated with patient survival and complications, more than LVEF <55%. However, we show that existing variables of the SRTR risk model largely capture the impact of previous cardiac revascularization on patient survival.