Kidney Transplant Candidates with Reduced Ejection Fraction: Risky Business or Not?

Background: Heart failure with reduced ejection fraction (HFrEF) is prevalent among patients with advanced chronic kidney disease. Data remains limited on whether HFrEF at the time of transplant is associated with an increased risk of graft failure and mortality. In this study, we sought to compare the patient and graft survival between the cohorts of patients with or without HFrEF undergoing kidney transplantation (KTx). Methods: In this retrospective case-control study, we performed a 1:2 matched cohort analysis of 103 KTx patients with pre-transplant EF ≤45% (HF cohort) and 206 patients with EF >45% (control cohort), transplanted between January 2011 - December 2021. Two cohorts were matched based on age, sex, donor type, and transplant year. Simultaneous liver-kidney transplants were excluded. Results: Baseline characteristics were similar except pre-emptive transplant and thymoglobulin induction were less frequent in the HF cohort. Despite increased delayed graft function (DGF) in the HF cohort, there was no statistically significant difference in the mean creatinine levels at 3-months (1.51 vs. 1.56) and 1-year (1.41 vs. 1.57) post-KTx between the control and HF cohorts (Table 1). At a mean follow-up period of 4.7 years, the two cohorts demonstrated similar overall graft survival and patient survival (Figure 1), with no statistically significant difference in the rates of graft loss due to acute rejection or death due to cardiovascular cause (Table 1). Conclusion: In our investigation, the graft and patient survival of control and HF cohorts were similar and comparable to the published ten-year KTx outcomes (PMID:26285695). Our data suggests low EF alone should not be a contraindication to KTx and is associated with acceptable long-term survival.