Evolutions in Combined Heart-Kidney Transplant

Area of Science:

• Cardiology
• Nephrology
• Transplantation Medicine

Background:

• Heart failure patients often develop kidney disease, impacting prognosis.
• Simultaneous heart-kidney transplantation (SHKT) is considered for select patients.
• Management and outcomes of SHKT require ongoing evaluation.

Purpose of the Study:

• To review management practices for SHKT candidates.
• To analyze outcomes associated with SHKT.
• To describe recent organ allocation policies for SHKT.

Main Methods:

• Literature review of SHKT management, outcomes, and allocation.
• Analysis of survival data comparing SHKT, heart transplantation (HT) alone, and kidney transplantation (KT) alone.
• Examination of recent organ allocation policy changes.

Main Results:

• SHKT offers survival benefits over HT alone in patients with severe kidney disease (eGFR < 40 mL/min/1.73 m² or dialysis dependence).
• SHKT is associated with poorer patient and kidney allograft survival compared to KT alone.
• A new organ allocation policy with stricter SHKT criteria was implemented in September 2023.

Conclusions:

• SHKT provides a survival advantage in specific heart failure and kidney disease populations.
• Kidney transplantation alone yields better long-term outcomes than SHKT.
• Further research and strategies are needed to optimize kidney function preservation in heart failure and post-transplant patients.