PurposeDespite the increasing number of heart-kidney transplants being performed in recent years, renal failure after heart transplantation remains a pervasive recipient complication. The purpose of this study was to determine the predictors and outcomes of renal failure after heart transplantation in a contemporary cohort.MethodsThis was a retrospective cohort study of all adults undergoing isolated heart transplantation in the 2018-2022 United Network for Organ Sharing database. Heart recipients were stratified into those experiencing postoperative renal failure requiring dialysis prior to discharge and those without renal failure. We used multivariable logistic regression to determine factors associated with postoperative renal failure and compared postoperative outcomes between groups.ResultsOf 10,545 patients undergoing heart transplantation, 1,485 (14%) experienced postoperative renal failure. Factors associated with increased odds of renal failure included: increasing creatinine (odds ratio, OR 2.09/mg/dL 95% CI 1.85-2.35), pretransplant dialysis (OR 4.83, 95% CI 3.46-6.74), ventilation (OR 1.86, 95% CI 1.28-2.69) or extracorporeal membrane oxygenation (OR 1.78, 95% CI 1.38-2.29) prior to transplant, and prior cardiac surgery (OR 1.41, 95% CI 1.25-1.59). Patients with renal failure following heart transplantation experienced markedly higher rates of primary graft dysfunction (5% vs 1%, P<0.001) and 30-day mortality as well as lower 1- and 3-year survival compared to those without renal failure (Figure).ConclusionRenal failure occurred frequently in a contemporary cohort of isolated heart transplant patients, with limited modifiable risk factors for its development. Renal-sparing strategies need to be considered in the care of heart transplant recipients with these known risk factors. Despite the increasing number of heart-kidney transplants being performed, these data suggest that additional patients may benefit from dual organ transplantation. Despite the increasing number of heart-kidney transplants being performed in recent years, renal failure after heart transplantation remains a pervasive recipient complication. The purpose of this study was to determine the predictors and outcomes of renal failure after heart transplantation in a contemporary cohort. This was a retrospective cohort study of all adults undergoing isolated heart transplantation in the 2018-2022 United Network for Organ Sharing database. Heart recipients were stratified into those experiencing postoperative renal failure requiring dialysis prior to discharge and those without renal failure. We used multivariable logistic regression to determine factors associated with postoperative renal failure and compared postoperative outcomes between groups. Of 10,545 patients undergoing heart transplantation, 1,485 (14%) experienced postoperative renal failure. Factors associated with increased odds of renal failure included: increasing creatinine (odds ratio, OR 2.09/mg/dL 95% CI 1.85-2.35), pretransplant dialysis (OR 4.83, 95% CI 3.46-6.74), ventilation (OR 1.86, 95% CI 1.28-2.69) or extracorporeal membrane oxygenation (OR 1.78, 95% CI 1.38-2.29) prior to transplant, and prior cardiac surgery (OR 1.41, 95% CI 1.25-1.59). Patients with renal failure following heart transplantation experienced markedly higher rates of primary graft dysfunction (5% vs 1%, P<0.001) and 30-day mortality as well as lower 1- and 3-year survival compared to those without renal failure (Figure). Renal failure occurred frequently in a contemporary cohort of isolated heart transplant patients, with limited modifiable risk factors for its development. Renal-sparing strategies need to be considered in the care of heart transplant recipients with these known risk factors. Despite the increasing number of heart-kidney transplants being performed, these data suggest that additional patients may benefit from dual organ transplantation.

10.1016/j.healun.2023.02.1577

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Impact of Supraventricular Tachycardia on Pregnancy Outcomes

CJC Open (2025)

A. Ardehali Marla Kiess Valerie Rychel Amanda Barlow Jennifer Oakes

:BackgroundParoxysmal supraventricular tachycardia (PSVT) is one of the most common arrhythmias in pregnant women. However, studies investigating the risk of PSVT in pregnancy are lacking. In pregnancy, we aimed to determine the: 1) proportion of women presenting with new-onset PSVT; 2) impact of prior PSVT history on episode severity and management; and 3) rate of adverse maternal and fetal/neonatal outcomes associated with PSVT.MethodsRetrospective case-control study: 77 consecutive pregnancies in 75 women referred to the St. Paul's Hospital Cardiac Obstetrics Clinic (2010-2022) with a history or new presentation of PSVT. Maternal obstetric and fetal/neonatal adverse outcomes were compared to a healthy control group.ResultsSixty-three pregnancies (82%) had a history of PSVT and 14 (18%) were new-onset in pregnancy. Sixty-eight percent of those with PSVT history had recurrence in pregnancy. Women with a recent history of PSVT within 5 years of pregnancy were more likely to experience recurrence compared to women with a remote history (81% vs. 31%, p<0.001). This group also experienced more frequent PSVT during pregnancy and increased rates of chemical cardioversion (38% vs. 13%, p=0.05). There were similar rates of adverse obstetric (8% vs. 2%, p=0.24) and fetal/neonatal outcomes (17% vs. 19%, p=0.72) between the PSVT group and controls.ConclusionsPSVT events were safely managed in pregnancy with similar obstetric and fetal/neonatal outcomes as controls. However, recurrence of PSVT during pregnancy is frequent and leads to management complexities among those with a history, reinforcing the need for pre-pregnancy counselling and catheter ablation for definitive management.

Supraventricular Tachycardia

10.1016/j.cjco.2025.01.008

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