Related Experiment Video
Updated: Dec 26, 2025
Murine Kidney Transplant Technique
Published on: October 20, 2015
Combined Heart-Kidney Transplant Versus Sequential Kidney Transplant in Heart Transplant Recipients
Michele Gallo1, Jaimin R Trivedi1, Erin M Schumer1
1Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
Insights
For heart transplant candidates with severe kidney dysfunction (eGFR <30 or dialysis), combined heart-kidney transplant (HKTx) offers better survival than sequential kidney transplant (SKTx). For those with moderate kidney impairment (eGFR 30-45), both HKTx and SKTx are viable options.
Area of Science:
- Nephrology
- Cardiology
- Transplant Surgery
Background:
- Patients with reduced kidney function undergoing heart transplantation lack clear guidelines for combined heart-kidney transplant (HKTx) versus sequential kidney transplant (SKTx).
- Preoperative estimated glomerular filtration rate (eGFR) is a key metric for assessing kidney function.
Purpose of the Study:
- To evaluate the optimal timing and approach for kidney transplantation in heart transplant recipients based on preoperative eGFR.
- To compare patient survival rates between HKTx and SKTx stratified by preoperative eGFR.
Main Methods:
- Utilized the United Network for Organ Sharing database (2000-2015).
- Analyzed survival data for HKTx and SKTx populations with preoperative eGFR <45 mL/min.
- Stratified analysis by eGFR levels: <30 mL/min (or dialysis) and 30-44 mL/min.
Main Results:
- In patients with eGFR <30 or on dialysis, HKTx (n=545) showed improved survival (81% at 5 years) compared to SKTx (n=80, 75% at 5 years; P=.04).
- For patients with eGFR 30-44 mL/min, survival rates were similar between HKTx (n=107) and SKTx (n=112) at 5 years (74% vs. 52%, P=.4).
- Median waiting time for kidney transplant in the SKTx group was 6 years for eGFR <30 and 4 years for eGFR 30-44.
Conclusions:
- Preoperative eGFR is a critical factor in deciding between HKTx and SKTx to optimize outcomes.
- HKTx is associated with better survival for heart transplant candidates with severe kidney dysfunction (eGFR <30 or dialysis).
- Both HKTx and SKTx are suitable options for patients with moderate renal impairment (eGFR 30-45).
Objectives:
In patients with reduced kidney function there are no established guidelines to suggest combined heart-kidney transplant (HKTx) versus sequential kidney transplant (SKTx) using preoperative value of estimated glomerular filtration (eGFR).
Methods:
The United Network for Organ Sharing database was queried from 2000 to 2015 to evaluate survival of HKTx and SKTx population stratified by preoperative eGFR rate <45 mL/min. Aim of the study was to assess the eGFR rate that is most beneficial to perform a concomitant or a SKTx at time of transplant evaluation.
Results:
In our analysis, patients who required SKTx are recipients that, after heart transplantation, developed or worsened kidney insufficiency due to calcineurin inhibitor nephrotoxicity. In recipients with eGFR <30 or dialysis, a total of 545 received HKTx and 80 received SKTx. The median waiting time between heart and kidney transplant in SKTx group was 6 years. The overall post-transplant survival was 81% and 80% and 75% and 59% at 5 and 1 years for the HKTx and SKTx groups, respectively (P = .04). In recipients with eGFR from 30 to 44, a total of 107 received HKTx and 112 received SKTx. The median waiting time between heart and kidney transplant in SKTx group was 4 years. Overall post-transplant survival showed no statistically significant differences in HKTx group (n=107) compared with SKTx group (n=112) and was 90% and 95% at 1 year and 74% and 52% at 5 years, respectively (P = .4) .
Conclusions:
To optimize organ and patient survival, eGFR value can be utilized to discern between HKTx versus SKTx in patients with decreased renal function at the time of heart transplantation. Patients with eGFR<30 or in dialysis presented better survival with HKTx, while both SKTx and HKTx are suitable for patients with eGFR between 30 and 45.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management