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Updated: Oct 20, 2025
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Cardiac Outcomes in Isolated Heart and Simultaneous Kidney and Heart Transplants in the United States
Krishna Adit Agarwal1, Het Patel1, Nikhil Agrawal1
1Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Insights
Simultaneous kidney and heart transplants (SKHT) offer survival benefits for dialysis-dependent patients and those at high risk of kidney injury post-heart transplant. SKHT improves cardiac graft survival compared to heart transplant alone.
Area of Science:
- Nephrology
- Cardiology
- Transplant Surgery
Background:
- Kidney dysfunction is common in advanced heart failure patients.
- Simultaneous kidney and heart transplants (SKHT) are increasingly used for end-stage heart failure with severe kidney dysfunction.
- SKHT criteria are not well-defined and vary by center.
Purpose of the Study:
- To compare patient and cardiac allograft survival between SKHT and heart transplant alone (HTA).
- To analyze outcomes in recipients with post-transplant acute kidney injury requiring renal replacement therapy (RRT).
Main Methods:
- Utilized the United Network for Organ Sharing (UNOS) database.
- Compared survival outcomes for SKHT versus HTA recipients.
- Conducted subgroup analysis for patients requiring RRT post-transplant.
Main Results:
- Patient survival was similar between SKHT and HTA (12.4 vs. 11.3 years).
- Dialysis-dependent patients showed greater survival advantage with SKHT (12.4 vs. 9.9 years).
- SKHT recipients had better cardiac graft survival (12.5 vs. 11.2 years) and significantly better survival after developing acute kidney injury requiring RRT (11.9 vs. 2.7 years).
Conclusions:
- SKHT should be considered for dialysis-dependent heart transplant candidates.
- Patients at high risk for post-transplant RRT may benefit from SKHT.
Introduction:
Kidney dysfunction is not uncommon in patients with advanced heart failure. Simultaneous kidney and heart transplants (SKHTs) have gained acceptance as a treatment for patients with end-stage heart failure and severe kidney dysfunction. United States saw a rise of 650% in SKHT from 2000 to 2019. Despite increasing number of SKHT, the selection criteria remain poorly defined and vary across transplant centers.
Methods:
We evaluated patient and cardiac allograft survival for SKHT and heart transplant alone (HTA) using the United Network for Organ Sharing (UNOS) database. We then performed a subgroup analysis in recipients with post-transplant acute kidney injury requiring renal replacement therapy (RRT) and compared outcomes between SKHT and HTA recipients.
Results:
Although patient survival was comparable between SKHT and HTA groups (12.4 vs. 11.3 years), patients dependent on dialysis pretransplant derived greater survival advantage from SKHT as compared with HTA (12.4 vs. 9.9 years). Cardiac graft survival was better in SKHT (12.5 vs. 11.2 years). Among patients who developed acute kidney injury requiring RRT postoperatively, SKHT recipients had a significantly better survival (11.9 vs. 2.7 years).
Conclusion:
Our data support consideration of SKHT in dialysis-dependent heart transplant candidates and suggest that patients who are at increased risk of requiring RRT after heart transplant may benefit from SKHT.
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01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:24Tissue Transplantation
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