Autosomal dominant polycystic kidney disease shows better survival after transplant
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Patients with autosomal dominant polycystic kidney disease have a preferable cardiac profile before transplantation and better survival and major adverse cardiovascular event-free survival rates vs. patients with other kidney diseases.
However, patients with autosomal dominant polycystic kidney disease (ADPKD) also have worsening valvular function and increasing sinus of Valsalva diameter.
“Kidney failure is a major risk factor for structural and ischemic heart disease. Cardiovascular disease remains the leading cause of mortality in patients with kidney disease. However, details on the prevalence of cardiovascular disease and its morbidity in ADPKD patients with kidney failure undergoing kidney transplantation and its progression following transplantation are limited,” Maroun Chedid, MD, a PGY-1 resident from the division of nephrology and hypertension in the department of medicine at the Mayo Clinic in Rochester, Minnesota, and colleagues wrote. They added, “Our study aims to evaluate the prevalence of cardiovascular abnormalities on echocardiography in ADPKD at the time of transplantation compared to patients with other causes of kidney failure and examine the overall survival and risk of cardiovascular events post-kidney transplantation.”
In a retrospective cohort study, researchers evaluated data on all adults who underwent kidney transplantation (n=3,377) at the Mayo Clinic sites in Minnesota, Florida and Arizona. Additionally, 2,736 patients who underwent at least one echocardiogram testing within 2 years of transplantation between 1993 and 2021 were included.
In addition to the 271 patients with ADPKD, researchers categorized any patients without ADPKD into two groups depending on the cause of their kidney failure: those with diabetic nephropathy (n=271) or those without diabetes and without ADPKD (NDNA) (n=271).
Researchers aimed to measure the prevalence of cardiac abnormalities on echocardiogram in patients with ADPKD and compare it with the two groups at the time of kidney transplantation.
Using Cox proportional hazard regression models, researchers predicted the impact of ADPKD on MACE after transplantation, adjusting for hypertension, smoking history, preemptive status and BMI. Additionally, researchers used Kaplan-Meier methods to examine patient survival and major adverse cardiovascular event (MACE)-free survival rates after transplantation.
Analyses revealed that the time of transplantation, patients with ADPKD had lower rates of left ventricular hypertrophy, mitral regurgitations and tricuspid regurgitations than those with diabetic nephropathy and patients without diabetes and without non-ADPKD. Additionally, patients with ADPKD showed less diastolic and systolic dysfunction at the time of transplantation.
Researchers found that patients with ADPKD had the most favorable survival after transplantation, with a median of 18.7 years vs. 12 years for the diabetic nephropathy group and 13.8 years for the NDNA group. However, patients with ADPKD showed a decline in valvular function and an increase in the sinus of Valsalva diameter after transplantation.
“Overall, ADPKD patients have a much more favorable outcome for both patient survival and MACE-free survival as compared to the diabetic and non-diabetic kidney disease groups even after adjustment for potential cofounders,” Chedid and colleagues wrote. They added, “The predictability of ADPKD’s clinical course and aggressive management of risk factors likely play a role in these favorable outcomes.”
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