Transcatheter aortic valve replacement outcomes in patients with native versus transplanted kidneys: Data from an international multicenter registry

Abstract Background Chronic kidney disease (CKD) has a negative impact on outcomes after transcatheter aortic valve replacement (TAVR). Data on outcomes in renal transplant recipients (RTRs) undergoing TAVR are scarce. We compared the outcomes in RTRs undergoing TAVR to matched patients with native kidneys and similar kidney function. Methods This retrospective cohort study used data from 16 TAVR centers (13,941 patients). The study cohort included 216 patients (72 RTRs and 144 matched controls). Results The mean estimated glomerular filtration rate (eGFR) was 39.2±23.6 vs. 44.5±23.6 mL/min for RTRs and control patients (p=0.149), with a similar CKD stage distribution. After TAVR, the eGFR declined among RTRs but remained stable for up to 1 year in controls ( P =0.021). Long-term hemodialysis was required in 19 (26.4%) RTRs and 20 (13.8%) controls (HR=2.09 95% CI 1.03-3.86; P =0.039) and was most often initiated during the periprocedural period (14 RTRs vs. 16 controls; P =0.039). After a median follow-up of 2.3 years, risk of death (29.2% vs. 31.9%) and death/hemodialysis (40.3% vs. 36.8%) was similar between the groups. The contrast volume/eGFR ratio was the strongest predictor of hemodialysis initiation (OR=1.64; 95% CI 1.36–1.97 per 1 unit increase; P P for interaction=0.022). Conclusions TAVR appears safe in RTRs with mortality rates similar to matched patients with native kidneys. However, RTRs carry an increased risk of progressive renal impairment and need for hemodialysis initiation after TAVR. Our data highlight the importance of minimizing contrast load during TAVR, particularly in RTRs.