Outcomes of Simultaneous Heart and Kidney Transplantation

Shinobu Itagaki; Nana Toyoda; Noah Moss; Donna Mancini; Natalia Egorova; Takahisa Mikami; Erick Sun; Yuki Bekki; Gregory Serrao; Anuradha Lala; Percy Boateng; David H Adams; Anelechi C Anyanwu

doi:10.1016/j.jacc.2022.11.053

Outcomes of Simultaneous Heart and Kidney Transplantation

J Am Coll Cardiol. 2023 Feb 28;81(8):729-740. doi: 10.1016/j.jacc.2022.11.053.

Authors

Affiliations

¹ Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA. Electronic address: shinobu.itagaki@mountsinai.org.
² Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA.
³ Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁴ Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁵ Department of Neurology, Tufts University School of Medicine, Boston, Massachusetts, USA.
⁶ Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

PMID: 36813371
DOI: 10.1016/j.jacc.2022.11.053

Abstract

Background: Simultaneous heart-kidney transplantation has been increasingly performed in end-stage heart failure patients with concurrent kidney dysfunction despite limited evidence supporting its indications and utility.

Objectives: The purpose of this study was to investigate the effects and utility of simultaneously implanted kidney allografts with various degrees of kidney dysfunction during heart transplantation.

Methods: Using the United Network for Organ Sharing registry, long-term mortality was compared in recipients with kidney dysfunction who underwent heart-kidney transplantation (n = 1,124) vs isolated heart transplantation (n = 12,415) in the United States between 2005 and 2018. In heart-kidney recipients, contralateral kidney recipients were compared for allograft loss. Multivariable Cox regression was used for risk adjustment.

Results: Long-term mortality was lower among heart-kidney recipients than among heart-alone recipients when recipients were on dialysis (26.7% vs 38.6% at 5 years; HR: 0.72; 95% CI: 0.58-0.89) or had a glomerular filtration rate (GFR) of <30 mL/min/1.73 m² (19.3% vs 32.4%; HR: 0.62; 95% CI: 0.46-0.82) and GFR of 30 to 45 mL/min/1.73 m² (16.2% vs 24.3%; HR: 0.68; 95% CI: 0.48-0.97) but not in GFR of 45 to 60 mL/min/1.73 m². Interaction analysis showed that the mortality benefit of heart-kidney transplantation continued up to GFR 40 mL/min/1.73 m². The incidence of kidney allograft loss was higher among heart-kidney recipients than among contralateral kidney recipients (14.7% vs 4.5% at 1 year; HR: 1.7; 95% CI: 1.4-2.1).

Conclusions: Heart-kidney transplantation relative to heart transplantation alone provided superior survival for dialysis-dependent recipients and non-dialysis-dependent recipients up to a GFR of approximately 40 mL/min/1.73 m² but at the cost of almost twice the risk of kidney allograft loss than contralateral kidney allograft recipients.

Keywords: allograft failure; listing criteria; multiorgan transplantation; safety net policy; simultaneous heart-kidney transplantation.

MeSH terms

Glomerular Filtration Rate
Graft Survival
Heart Transplantation*
Humans
Kidney
Kidney Transplantation*
Renal Insufficiency*
Retrospective Studies
United States