Optimal patient selection for simultaneous heart-kidney transplant: A modified cost-effectiveness analysis

Area of Science:

• Transplantation Medicine
• Organ Allocation Policy
• Nephrology

Background:

• Rising rates of simultaneous heart-kidney (SHK) transplants strain deceased donor kidney (DDK) availability.
• Current organ allocation policies lack specific eligibility criteria for SHK transplants.
• Comorbid kidney dysfunction is common in heart transplant candidates.

Purpose of the Study:

• To evaluate the efficiency of SHK transplants versus a "Safety Net" strategy for heart transplant candidates with kidney dysfunction.
• To identify patient subsets who benefit most from SHK transplants.
• To inform the development of objective criteria for SHK transplant eligibility.

Main Methods:

• Decision-analytic modeling was employed to compare SHK and Safety Net strategies.
• Quality-adjusted life year (QALY) gains were calculated for DDK allocation scenarios.
• Efficiency was assessed based on QALYs gained per DDK used.

Main Results:

• For an average candidate with 50% native kidney recovery probability post-heart transplant, SHK yielded 0.64 more QALYs but used 0.58 more DDKs than Safety Net.
• SHK was less efficient (1.1 QALYs/DDK) than kidney transplant-only (2.2 QALYs/DDK) in this average scenario.
• SHK was only preferred over Safety Net for candidates with a low native kidney recovery probability (24%-38%).

Conclusions:

• A Safety Net strategy is generally more efficient for allocating DDKs compared to SHK transplants.
• SHK transplants are only justifiable for specific patient groups with a high likelihood of kidney failure post-heart transplant.
• Objective criteria, favoring a Safety Net approach, should be established for SHK transplant eligibility.