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Heart-Kidney Transplants Linked to Better Outcomes Compared to Heart-Only Transplants in Children with

Ruchi Gupta Mahajan, Michael D Evans, Sarah J Kizilbash

    Research Square
    |June 5, 2025
    PubMed

    Insights

    Simultaneous heart-kidney transplants improve survival for children with advanced chronic kidney disease (CKD) awaiting heart transplants. This approach offers better patient and graft survival compared to heart-only transplants in this vulnerable pediatric population.

    Area of Science:

    • Pediatric Cardiology
    • Nephrology
    • Transplantation Medicine

    Background:

    • Chronic kidney disease (CKD) increases risks for children needing heart transplants.
    • Optimal management for advanced CKD (stage 3b+) in pediatric heart failure patients is uncertain.
    • The choice between simultaneous heart-kidney vs. heart-only transplant requires clarification.

    Purpose of the Study:

    • To compare patient and graft survival rates.
    • To evaluate outcomes of simultaneous heart-kidney transplantation versus heart-only transplantation.
    • To analyze data in pediatric heart transplant recipients with advanced CKD.

    Main Methods:

    • Utilized the Scientific Registry of Transplant Recipients (SRTR) database.
    • Identified pediatric heart transplant recipients (age ≤ 18) with eGFR < 45 mL/min/1.73 m².
    • Employed covariate-balancing propensity scores for weighted comparison of simultaneous heart-kidney (n=21) vs. heart-only (n=839) recipients.

    Main Results:

    • Simultaneous heart-kidney recipients showed significantly higher patient survival (HR: 0.29; P=0.02).
    • Heart graft survival was also significantly better in the simultaneous group (HR: 0.24; P=0.002).
    • These benefits were observed in children with non-dialysis-dependent CKD stage 3b or higher.

    Conclusions:

    • Simultaneous heart-kidney transplantation is linked to superior patient survival.
    • Simultaneous heart-kidney transplantation demonstrates improved heart graft survival.
    • This strategy is recommended for pediatric patients with advanced CKD undergoing heart transplantation.

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