Cohort study: "Outcomes of kidney transplantation in patients with prosthetic heart valves".

The number of kidney transplant candidates with prosthetic heart valves (PHVs) is increasing. Yet, outcomes of kidney transplantation in these patients are still unclear. This is the first report of post-transplant outcomes in patients with PHVs at time of kidney transplantation. We conducted a matched cohort study among recipients from the multicentric and prospective DIVAT cohort to compare the outcomes in patients with left-sided PHVs at time of transplantation and a group of recipients without PHV matched according to age, dialysis time, initial disease, pretransplant DSA, diabetes, and cardiovascular events. Of 23 018 patients, 92 patients with PHVs were included and compared to 276 patients without PHV. Delayed graft function and postoperative bleeding occurred more frequently in patients with PHVs. Kidney graft survival was similar between groups. 5-year overall survival was 68.5% in patients with PHV vs. 87.9% in patients without PHV [HR, 2.72 (1.57-4.70), P = 0.0004]. Deaths from infection, endocarditis, and bleeding were more frequent in patients with PHV. Mechanical valves, but not bioprosthetic valves, were independent risk factors for mortality [HR, 2.89 (1.68-4.97), P = 0.0001]. Patients with PHV have high mortality rates after kidney transplantation. These data suggest that mechanical valves, but not biological valves, increase risks of post-transplant mortality.

Knowledge of Chronic Hemodialysis Patients on Kidney Transplantation in Morocco.

BACKGROUND: Kidney transplantation (KT) is the optimal treatment for chronic end-stage renal failure. However, it is experiencing a huge delay in Morocco, and the lack of information on this alternative treatment could contribute to this delay. The purpose of our work is to evaluate the knowledge of hemodialysis (HD) on renal transplantation and to propose sensitization and information strategies. METHODS: This is a multicenter study conducted in 4 hemodialysis centers in Marrakesh from November to December 2017. An individual questionnaire was submitted to 310 patients concerning sociocultural status, willingness to be transplanted, the main benefits and risks of renal transplantation, knowledge of religious attitudes toward organ donation and transplantation, cost, and survival of the KT. RESULTS: Of the 310 patients, 56% were men, with a mean age of 49.43 ± 10.3 years. The mean duration of hemodialysis was 6.7 ± 5.3 years. Only 18% were in school, and 57% had moderate economic status. Of the 310 respondents, 71% said they wanted to be transplanted, and 15.5% believed that Islam was unfavorable by encouraging them to accept the fate that God chose for them. The rest were afraid of multiple complications and returning to dialysis. However, 41.7% thought transplantation was more expensive than hemodialysis. Only 65.8% believed that renal transplantation provided a better quality of life. CONCLUSIONS: Raising the awareness of hemodialysis patients and their families is essential to promote KT in Morocco.