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Outcomes After Kidney Transplantation of Patients Previously Diagnosed With Atrial Fibrillation
Author(s) -
Lenihan C. R.,
MontezRath M. E.,
Scandling J. D.,
Turakhia M. P.,
Winkelmayer W. C.
Publication year - 2013
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.12197
Subject(s) - medicine , hazard ratio , atrial fibrillation , stroke (engine) , kidney transplantation , cardiology , proportional hazards model , atrial flutter , heart failure , transplantation , confidence interval , surgery , mechanical engineering , engineering
Little is known about the prevalence and outcomes of patients with atrial fibrillation/flutter (AF) who receive a kidney transplant. We identified all patients who had >1 year of uninterrupted Medicare A+B coverage before receiving their first kidney transplant (1997–2009). The presence of pretransplant AF was ascertained from diagnosis codes in Medicare physician claims. We studied the posttransplant outcomes of death, all‐cause graft failure, death‐censored graft failure and stroke using multivariable Cox regression. Of 62 706 eligible first kidney transplant recipients studied, 3794 (6.4%) were diagnosed with AF prior to kidney transplant. Over a mean follow up of 4.9 years, 40.6% of AF patients and 24.9% without AF died. All‐cause and death‐censored graft failure were 46.8% and 16.5%, respectively, in the AF group and 36.4% and 19.5%, respectively, in those without AF. Ischemic stroke occurred in 2.8% of patients with and 1.6% of patients without AF. In patients with AF, multivariable‐adjusted hazard ratios (95% confidence intervals) for death, graft failure, death‐censored graft failure and ischemic stroke were 1.46 (1.38–1.54), 1.41 (1.34–1.48), 1.26 (1.15–1.37) and 1.36 (1.10–1.68), respectively. Pre‐existing AF is associated with poor posttransplant outcomes. Special attention should be paid to AF in pretransplant evaluation, counseling and risk stratification of kidney transplant candidates.