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Contemporary Immunosuppression Management and 1-Year Outcomes in Dual Organ Heart Transplantation
Xinyi Huang1,2, David Salerno1, Danielle Kovac1
1Department of Pharmacy, New York Presbyterian Hospital, New York, New York, USA.
Insights
This study examined immunosuppression strategies and outcomes for dual organ heart transplant recipients. Heart-kidney recipients showed lower 1-year survival compared to heart-lung and heart-liver patients.
Area of Science:
- Cardiology
- Transplantation Immunology
- Nephrology
- Hepatology
- Pulmonology
Background:
- Limited data exists on immunosuppression and outcomes for dual organ heart transplant recipients, especially post-2018 allocation policy changes.
- Recent findings suggest comparable outcomes for heart-lung and heart-liver transplants, but worse survival for heart-kidney recipients.
- Understanding these outcomes is crucial for optimizing patient care and management.
Purpose of the Study:
- To evaluate immunosuppression strategies and clinical outcomes in adult heart-kidney, heart-liver, and heart-lung transplant recipients.
- To analyze infectious complications and graft outcomes within the first 12 months post-transplant.
- To provide insights into the real-world effectiveness of current immunosuppression protocols.
Main Methods:
- A single-center retrospective study included 36 adult dual organ heart transplant recipients (kidney, liver, lung) from September 2019 to May 2023.
- Data collected included immunosuppression regimens, infectious complications, and graft outcomes over a 12-month period.
- Statistical analysis focused on comparing outcomes across different dual organ transplant groups.
Main Results:
- Basiliximab was the most common induction agent across all groups.
- Triple immunosuppression was standard at 12 months, with one heart-liver recipient achieving prednisone wean.
- Infection complications were high (95% kidney, 75% liver, 100% lung).
- One-year survival rates were 85% for heart-kidney, 78% for heart-liver, and 86% for heart-lung recipients.
- Graft outcomes included one case of focal segmental glomerulosclerosis leading to dialysis and one chronic lung allograft dysfunction; no severe rejection or retransplants were noted.
Conclusions:
- This study provides a summary of real-world immunosuppression strategies and outcomes in dual organ heart transplant recipients.
- Heart-kidney transplant recipients experienced lower 1-year survival rates compared to heart-lung and heart-liver recipients.
- Further research is warranted to optimize immunosuppression and improve outcomes for these complex patient populations.
Background:
There have been limited reports on immunosuppression strategies and outcomes in dual organ heart transplant populations, primarily from before the 2018 United Network for Organ Sharing (UNOS) heart allocation policy change. Recent data suggested that outcomes with heart-lung and heart-liver transplants remained comparable in the new allocation era, yet heart-kidney recipients have worse 1-year survival.
Methods:
This single-center retrospective study evaluated adult heart-kidney, heart-liver, and heart-lung transplant recipients from September 2019 to May 2023. Immunosuppression regimen, infectious complications, and graft outcomes were collected for 12 months.
Results:
A total of 36 patients (kidney n = 20, liver n = 9, and lung n = 7) were included in this study. Basiliximab was the most commonly employed induction strategy across the organ groups (12/20 in kidney, 4/9 in liver, and 7/7 in lung). All patients were on triple immunosuppression at 12 months posttransplant with prednisone wean achieved in one heart-liver recipient. Infection complications were frequently reported (95% kidney, 75% liver, 100% lung group). One patient went back to dialysis due to focal segmental glomerulosclerosis. One chronic lung allograft dysfunction was reported, but no other severe biopsy-proven rejection or retransplant was reported. The 1-year survival was 85% (17/20) in heart-kidney, 78% (7/9) in heart-liver, and 86% (6/7) in heart-lung recipients.
Conclusion:
This study summarized real-world immunosuppression strategies and outcomes in dual organ heart transplant recipients.
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