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Updated: Apr 17, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
The survival benefit of simultaneous heart-kidney transplantation extends beyond dialysis-dependent patients
Arman Kilic1, Joshua C Grimm1, Glenn J R Whitman1
1Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
Insights
Simultaneous heart-kidney transplantation (SHK) significantly improves survival for dialysis-dependent patients and those with reduced kidney function at high risk for dialysis post-transplant. This suggests SHK could benefit more patients.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Simultaneous heart-kidney transplantation (SHK) is a complex procedure with survival outcomes that may vary based on preoperative renal function.
- Understanding the impact of SHK on survival across different levels of kidney function is crucial for optimizing patient selection and resource allocation.
Purpose of the Study:
- To evaluate the effect of simultaneous heart-kidney transplantation (SHK) on long-term survival.
- To stratify survival outcomes based on preoperative renal function and the risk of developing new-onset dialysis post-transplant.
Main Methods:
- A retrospective analysis of the United Network for Organ Sharing database (1992-2012) comparing SHK and heart transplant alone (HTA) recipients.
- Patients were stratified by dialysis dependence, preoperative glomerular filtration rate (GFR), and a validated risk score for postoperative renal failure.
- Five-year survival was assessed using Kaplan-Meier analysis and multivariable logistic regression.
Main Results:
- SHK significantly improved 5-year survival in dialysis-dependent patients (69% vs. 54%, p < 0.001).
- No survival difference was observed in patients with preoperative GFR ≥60 mL/min/1.73 m².
- In patients with GFR <60 mL/min/1.73 m², SHK improved survival for those at high risk of postoperative dialysis (86% vs. 67%, p < 0.001), but not for low-risk patients (82% vs. 76%, p = 0.27).
Conclusions:
- Simultaneous heart-kidney transplantation enhances long-term survival in dialysis-dependent patients and select non-dialysis patients with reduced GFR at high risk for post-transplant renal failure.
- The findings suggest that SHK could be expanded to include patients with reduced preoperative GFR who are identified as high risk for new-onset dialysis, warranting further investigation due to current low utilization.
Background:
This study evaluated the effect of simultaneous heart-kidney transplantation (SHK) on survival stratified by preoperative renal function.
Methods:
Patients undergoing SHK or heart transplant alone (HTA) between 1992 and 2012 were identified in the United Network for Organ Sharing database. Patients were primarily stratified by the need for dialysis before transplantation. Nondialysis patients were further stratified by preoperative glomerular filtration rate (GFR) and likelihood of postoperative development of renal failure requiring new-onset dialysis (high risk defined as ≥75th percentile according to a previously derived and validated risk score). The primary outcome was 5-year survival, evaluated by Kaplan-Meier and multivariable logistic regression analyses.
Results:
Included were 665 (2%) SHK and 38,488 (98%) HTA patients. SHK improved 5-year survival in dialysis-dependent patients (69% vs 54%, p < 0.001), with no survival difference in patients with a preoperative GFR ≥60 mL/min/1.73 m(2) (84% SHK vs 77% HTA, p = 0.34). In patients with a preoperative GFR of less than 60 mL/min/1.73 m(2), being high risk for postoperative new-onset dialysis discriminated those patients who would benefit from SHK (5-year survival low risk: 82% SHK vs 76% HTA, p = 0.27; 5-year survival high risk: 86% SHK vs 67% HTA, p < 0.001). Risk-adjusted analysis confirmed these findings. SHK comprised only 2.6% of heart transplants in patients with a preoperative GFR of less than 60 mL/min/1.73 m(2) who were at high risk for postoperative renal failure.
Conclusions:
SHK improves long-term survival not only in dialysis-dependent patients but also in patients with reduced preoperative GFR who are at high risk for postoperative new-onset dialysis. Expansion of SHK into this subset warrants further study, especially considering its low current utilization.
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01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
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