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Simultaneous Heart and Kidney Transplantation: A Systematic Review and Proportional Meta-Analysis of Its
Natália Zaneti Sampaio1, Matheus Daniel Faleiro2, Laynara Vitória da Silva Vieira3
1University of Araraquara, Araraquara, Brazil.
Insights
Simultaneous heart and kidney transplants offer a viable solution for patients with end-stage heart disease and kidney insufficiency. This procedure demonstrates acceptable organ rejection rates and favorable long-term survival outcomes.
Area of Science:
- Cardiology
- Nephrology
- Transplantation Science
Background:
- End-stage heart disease often coexists with kidney insufficiency, necessitating combined organ support.
- Simultaneous heart and kidney transplantation is a critical option for patients with concurrent cardiac and renal failure.
- Understanding the characteristics and long-term outcomes of this combined procedure is essential for patient management.
Approach:
- A meta-analysis was conducted to assess recipient characteristics, operative variables, and long-term outcomes.
- Screened 781 studies, thoroughly reviewed 33, and included 15 retrospective cohort studies involving 376 patients.
- Analyzed data on patient demographics, indications for transplantation, graft function, rejection episodes, and survival rates.
Key Points:
- The average recipient age was 51.1 years, with 84% being male and 71% dialysis-dependent.
- Ischemic cardiomyopathy (47%) and cardiorenal syndrome (22%) were primary indications.
- Delayed graft function occurred in 33% of patients, with simultaneous rejection in only 5 cases.
Conclusions:
- Simultaneous heart and kidney transplantation is a significant therapeutic option for combined cardiac and renal dysfunction.
- The procedure shows promising results with acceptable rates of organ rejection.
- Long-term survival rates are favorable, with 71% survival at 5 years post-transplantation.
Abstract:
Patients with end-stage heart disease who undergo a heart transplant frequently have simultaneous kidney insufficiency, therefore simultaneous heart and kidney transplantation is an option and it is necessary to understand its characteristics and long-term variables. The recipient characteristics and operative and long-term variables were assessed in a meta-analysis. A total of 781 studies were screened, and 33 were thoroughly reviewed. 15 retrospective cohort studies and 376 patients were included. The recipient's mean age was 51.1 years (95% CI 48.52-53.67) and 84% (95% CI 80-87) were male. 71% (95% CI 59-83) of the recipients were dialysis dependent. The most common indication was ischemic cardiomyopathy [47% (95% CI 41-53)] and cardiorenal syndrome [22% (95% CI 9-35)]. Also, 33% (95% CI 20-46) of the patients presented with delayed graft function. During the mean follow-up period of 67.49 months (95% CI 45.64-89.33), simultaneous rejection episodes of both organ allografts were described in 5 cases only. Overall survival was 95% (95% CI 88-100) at 30 days, 81% (95% CI 76-86) at 1 year, 79% (95% CI 71-87) at 3, and 71% (95% CI 59-83) at 5 years. Simultaneous heart and kidney transplantation is an important option for concurrent cardiac and renal dysfunction and has acceptable rejection and survival rates.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure