Outcomes in Patients With LVADs Undergoing Simultaneous Heart-Kidney Transplantation

Area of Science:

• Cardiology
• Nephrology
• Transplant Surgery

Background:

• Previous studies indicate superior outcomes for simultaneous heart-kidney transplants (sHKT) over isolated orthotopic heart transplants (iOHT) in chronic kidney disease (CKD) patients.
• However, outcomes for CKD patients supported by durable left ventricular assist devices (LVADs) undergoing these procedures remain understudied.

Purpose of the Study:

• To evaluate and compare post-transplant survival and outcomes for patients with durable LVADs and advanced CKD undergoing either sHKT or iOHT.
• To identify predictors of 1-year post-transplant mortality in this specific patient population.

Main Methods:

• Retrospective analysis of the United Network for Organ Sharing registry (2008-2020).
• Inclusion criteria: patients with durable LVADs and stage 3+ CKD undergoing iOHT or sHKT.
• Statistical analysis included Kaplan-Meier survival analysis and multivariable modeling for mortality predictors.

Main Results:

• A total of 4375 patients were analyzed (366 sHKT, 4009 iOHT).
• The 1-year post-transplant survival rate was significantly lower for sHKT recipients (80.3%) compared to iOHT recipients (88.3%) (P < 0.001).
• sHKT was associated with increased need for post-transplant dialysis, longer hospital stays, and remained an independent risk factor for 1-year mortality (OR 1.58; P=0.002).

Conclusions:

• Simultaneous heart-kidney transplantation is increasingly utilized in LVAD patients with CKD.
• Despite this trend, sHKT is associated with worse short- and long-term survival and a higher likelihood of requiring post-transplant dialysis compared to iOHT.
• These findings suggest a need for careful patient selection and further investigation into the factors influencing sHKT outcomes in this population.