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Published on: July 15, 2015
Perioperative Timing Impacts Renal Graft Outcomes in Simultaneous Heart-Kidney Transplantation
Brendan P Lovasik1,2, Neeta Vachharajani2, Paighton Miller2
1Section of Transplant Surgery, Washington University in St. Louis, St. Louis, Missouri, USA.
Insights
Concurrent simultaneous heart-kidney (SHK) transplants show better outcomes than staggered procedures. This study found concurrent SHK transplantation is linked to lower delayed graft function and improved patient survival.
Area of Science:
- Cardiology
- Nephrology
- Transplantation Medicine
Background:
- Simultaneous heart-kidney (SHK) transplantation treats end-stage cardiorenal disease.
- The impact of renal transplant timing (concurrent vs. staggered) on SHK outcomes is unknown.
Purpose of the Study:
- To investigate the impact of renal transplant timing on post-transplant outcomes in SHK recipients.
- To compare outcomes between concurrent and staggered SHK transplant procedures.
Main Methods:
- Retrospective analysis of the UNOS STAR database (2010-2024).
- Inclusion of institutional SHK transplant data for patient-level factors.
- Comparison of outcomes based on concurrent versus staggered renal transplant timing.
Main Results:
- Staggered SHK transplants (66.7%) were more common than concurrent (33.3%).
- Staggered SHK was associated with higher delayed graft function (31.4% vs. 25.6%) and lower 1-year renal graft survival (84.5% vs. 89.9%).
- Multivariable analysis confirmed staggered SHK had higher DGF risk (HR 1.29) and lower 1-year graft survival (HR 1.39), and lower overall patient survival (HR 0.81).
Conclusions:
- Renal transplant timing significantly impacts SHK transplantation outcomes.
- Concurrent SHK transplantation demonstrates superior outcomes compared to staggered procedures in a large national dataset.
Background:
Simultaneous heart-kidney (SHK) transplantation is widely administered as a treatment for end-stage cardiorenal disease. However, the impact of renal transplant timing as a concurrent (heart and kidney transplanted simultaneously) or staggered (heart transplant followed by kidney transplant) procedure on post-transplant outcomes has not been investigated.
Methods:
We conducted a retrospective analysis of the UNOS STAR for SHK transplants that occurred in the United States between 2010 and 2024. Institutional SHK transplant data were similarly reviewed for specific patient-level factors.
Results:
Approximately two-thirds (N = 1668) of SHK transplants were performed using the staggered approach, with the remaining one-third performed concurrently (N = 868). Univariate analysis of concurrent versus staggered SHK transplants indicated that staggered SHK transplant was associated with a higher rate of delayed graft function (DGF; 31.4 vs. 25.6%, respectively; p = 0.003) and lower 1-year renal graft survival (89.9 vs. 84.5%, respectively; p < 0.001). A multivariable regression analysis showed that these differences in DGF (HR 1.29, 95% CI 1.05-1.58, p = 0.014) and 1-year graft survival (HR 1.39, 95% CI 1.05-1.83, p = 0.020) remained when other factors were controlled. In multivariable Cox analysis, staggered SHK was associated with lower overall patient survival (HR 0.81, p = 0.045) but no differences in death-adjusted graft survival or need for renal retransplantation (both p > 0.05).
Conclusions:
The results from this study indicate that discrepant outcomes in SHK transplantation result from the timing of renal transplantation, with concurrent SHK demonstrating superior outcomes in a large national dataset.
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