Is Chronic Kidney Disease Truly a Contraindication for Total Artificial Heart Candidacy and Subsequent Heart Transplantation.

Patients with severe heart disease may develop end-stage biventricular heart failure. These patients may require the placement of a total artificial heart (TAH). In many programs, chronic kidney disease (CKD) has been a relative contraindication for those patients with severe biventricular heart disease needing a total artificial heart. For these patients, kidney dialysis (if needed) is not available for outpatients. Furthermore, it is not known if CKD in TAH patients compromises post-transplant outcomes. Between 2011 and 2019, we assessed 20 TAH patients who developed CKD defined as GFR less than 60 mL/min 90 days apart prior to transplant listing. At transplant listing, these patients have GFR less than 30 mL/min. These patients would be listed for combined heart-kidney transplantation (HKTx) being on the TAH. Study endpoints included: 3- and 6-month waitlist mortality and 30-day and 1-year post-transplant survival were recorded. A control group was comprised of patients with TAH placement listed for transplant with heart alone. 3- and 6-month waitlist mortality were similar for TAH patients with CKD compared to TAH patients without CKD. Post-transplant, the two groups had similar survival at 30 days and 1 year. Patients needing chronic dialysis in the first-year post-transplant was similarly observed in 13.3% of TAH patients with CKD and 8.1% of TAH patients without CKD. (See table) Chronic kidney disease is not a contraindication for TAH or subsequent heart transplantation. [ABSTRACT FROM AUTHOR]