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Updated: Jul 22, 2025
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Improved waitlist and comparable post-transplant outcomes in simultaneous heart-kidney transplantation under the 2018
Yeahwa Hong1, Nicholas R Hess2, Luke A Ziegler2
1Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Insights
The 2018 heart allocation policy change improved waitlist outcomes for simultaneous heart-kidney transplantation, reducing wait times and increasing transplant rates. Early post-transplant survival remained comparable after the policy update.
Area of Science:
- Transplantation Medicine
- Organ Allocation Policy
- Cardiovascular Surgery
Background:
- Simultaneous heart-kidney transplantation (SHKT) is a complex procedure for patients with end-stage heart and kidney disease.
- The 2018 organ allocation policy update aimed to optimize organ distribution and patient outcomes.
- Evaluating the impact of policy changes on SHKT is crucial for refining allocation strategies.
Purpose of the Study:
- To assess clinical trends in SHKT before and after the 2018 US heart allocation policy change.
- To analyze the impact of the policy change on waitlist outcomes and post-transplant survival in SHKT.
- To determine the risk-adjusted mortality associated with the 2018 allocation system for SHKT.
Main Methods:
- Retrospective analysis of the United Network for Organ Sharing registry for adult SHKT patients.
- Comparison of waitlist and post-transplant outcomes before and after the 2018 policy change.
- Multivariable analyses to evaluate risk-adjusted hazards for waitlist and post-transplant mortality.
Main Results:
- The 2018 policy change led to increased SHKT rates, shorter waitlist times, and reduced likelihood of de-listing.
- Post-transplant outcomes, including 90-day, 6-month, and 1-year survival and complication rates, were comparable before and after the policy change.
- The 2018 allocation system significantly reduced risk-adjusted 1-year waitlist mortality but did not significantly impact 1-year post-transplant mortality.
Conclusions:
- The 2018 heart allocation policy enhanced SHKT by improving waitlist metrics.
- Early post-transplant survival following SHKT remained consistent despite the policy modifications.
- The policy update demonstrated a positive effect on waitlist mortality, highlighting its benefit for patients awaiting dual organ transplants.
Objective:
This study aimed to investigate the clinical trends and the impact of the 2018 heart allocation policy change on both waitlist and post-transplant outcomes in simultaneous heart-kidney transplantation in the United States.
Methods:
The United Network for Organ Sharing registry was queried to compare adult patients before and after the allocation policy change. This study included 2 separate analyses evaluating the waitlist and post-transplant outcomes. Multivariable analyses were performed to determine the 2018 allocation system's risk-adjusted hazards for 1-year waitlist and post-transplant mortality.
Results:
The initial analysis investigating the waitlist outcomes included 1779 patients listed for simultaneous heart-kidney transplantation. Of these, 1075 patients (60.4%) were listed after the 2018 allocation policy change. After the policy change, the waitlist outcomes significantly improved with a shorter waitlist time, lower likelihood of de-listing, and higher likelihood of transplantation. In the subsequent analysis investigating the post-transplant outcomes, 1130 simultaneous heart-kidney transplant recipients were included, where 738 patients (65.3%) underwent simultaneous heart-kidney transplantation after the policy change. The 90-day, 6-month, and 1-year post-transplant survival and complication rates were comparable before and after the policy change. Multivariable analyses demonstrated that the 2018 allocation system positively impacted risk-adjusted 1-year waitlist mortality (sub-hazard ratio, 0.66, 95% CI, 0.51-0.85, P < .001), but it did not significantly impact risk-adjusted 1-year post-transplant mortality (hazard ratio, 1.03; 95% CI, 0.72-1.47, P = .876).
Conclusions:
This study demonstrates increased rates of simultaneous heart-kidney transplantation with a shorter waitlist time after the 2018 allocation policy change. Furthermore, there were improved waitlist outcomes and comparable early post-transplant survival after simultaneous heart-kidney transplantation under the 2018 allocation system.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management