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Factors Impacting Early Adverse Outcomes in Simultaneous Heart-Kidney Transplantation
Bernard John DuBray1, Saed Shawar2, Sandip Zalawadiya3
1Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee.
Transplantation Proceedings
|January 21, 2025
Summary
Pre-transplant dialysis and longer cold ischemia time increase early adverse outcomes in simultaneous heart-kidney transplants (SHKTs). Expediting kidney transplant after heart transplant may improve outcomes.
Area of Science:
- Nephrology
- Cardiology
- Transplant Surgery
Background:
- Simultaneous heart-kidney transplants (SHKTs) are increasing.
- Limited data exists on renal allograft outcomes in these high-acuity patients.
- Early adverse outcomes (EAOs) like delayed graft function (DGF), primary non-function (PNF), and renal allograft futility (RAF) are critical concerns.
Purpose of the Study:
- To identify variables associated with EAOs after SHKTs.
- To analyze recipient and operative factors influencing DGF, PNF, and RAF.
- To inform strategies for improving SHKT outcomes.
Main Methods:
- Single-center retrospective review of adult SHKTs (October 2011 - August 2021).
- Multivariable logistic regression models used to assess relationships between variables and EAOs.
- Key variables included pre-transplant dialysis, intra-aortic balloon pump, serum lactate, norepinephrine use, re-do sternotomy, and cold ischemia time (CIT).
Main Results:
- Sixty-eight SHKTs were performed; 35% experienced DGF, 6% PNF, and 18% RAF.
- Pre-transplant dialysis, serum lactate, and CIT were linked to higher DGF likelihood.
- Norepinephrine (NE) use and CIT were associated with increased RAF.
Conclusions:
- Pre-transplant dialysis is a significant risk factor for EAOs post-SHKT.
- Cold ischemia time and norepinephrine use contribute to renal allograft futility.
- Expediting kidney transplantation post-heart transplant may reduce EAOs by mitigating hemodynamic and ischemic stress.
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