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Master Thesis

Pronostic des transplantations rénales chez les patients porteurs de prothèse valvulaire cardiaque

Abstract : Introduction: The number of kidney transplant candidates with prosthetic heart valves is increasing. We provide the first report of post-transplant outcomes in patients with a prosthetic heart valve at time of transplantation.
Methods: We conducted a matched cohort study among kidney transplant recipients from the French multicentric and prospective DIVAT cohort. All patients with a left-sided mechanical or bioprosthetic valve at time of transplantation were included and matched (3:1) with a control group regarding age, pre-transplant dialysis, recurrent renal disease, diabetes, cardiovascular events and pre-transplant donor-specific antibodies.
Results: Of 23018 kidney transplant recipients in the database, 368 were included in the study, 92 (0.4%) of whom had a prosthetic heart valve (PHV) and 276 were controls. More patients experienced delayed graft function in the PHV group (34.8% vs 14.1%, p<0.0001). Kidney graft survival was similar between groups. 5-year overall survival was 68.5 % in the PHV group versus 87.9 % in the control group (HR, 2.72 [1.57–4.70], p=0.0004 by log rank). In contrast with a bioprosthetic valve, a mechanical valve at time of transplantation was an independent risk factor for mortality (HR, 2.89 [1.68-4.97], p=0.0001) together with recipient age, pre-transplant dialysis time, history of diabetes and cardiac events. Deaths from bleeding were more frequent in patients with mechanical valves (14.2% of deaths vs 0% in the bioprosthetic and control groups, p=0.03).
Conclusion: The presence of a mechanical heart valve at time of kidney transplantation is a risk factor for post-transplant mortality. These data will help clinical teams to assess transplant-eligibility in patients with PHV. They suggest that bioprosthetic heart valves may be the best option for patients with end-stage kidney disease who can be candidates for transplantation.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03155012
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Submitted on : Friday, July 9, 2021 - 11:16:15 AM
Last modification on : Tuesday, July 13, 2021 - 3:24:01 AM
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  • HAL Id : dumas-03155012, version 1
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Hajar Ouahmi. Pronostic des transplantations rénales chez les patients porteurs de prothèse valvulaire cardiaque. Médecine humaine et pathologie. 2020. ⟨dumas-03155012⟩

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