Combined Multiorgan Heart and Kidney Transplants With Single Donor Allografts: Simultaneous Versus Staged?

Area of Science:

• Nephrology
• Cardiology
• Transplant Surgery

Background:

• Heart and kidney transplants (HKTx) are increasing for end-stage heart failure and kidney disease.
• No established protocols exist for simultaneous versus staged HKTx.

Purpose of the Study:

• To compare outcomes of simultaneous versus staged same-donor HKTx.
• To analyze post-transplant clinical characteristics, mortality, and graft failure.

Main Methods:

• Utilized SRTR data (1993-2023).
• Compared simultaneous HKTx with staged HKTx (kidney transplant within 1 day of heart transplant).
• Assessed outcomes using average treatment effect, Kaplan-Meier curves, and instrumental variable analysis.

Main Results:

• Staged HKTx proportion increased from 20.7% (2015) to 58.8% (2023).
• Simultaneous HKTx had shorter kidney cold ischemic time and hospital stays.
• Weighted patient mortality and graft failure were slightly lower in simultaneous HKTx, but adjusted analyses showed no significant differences.

Conclusions:

• Simultaneous HKTx is associated with shorter hospital stays and lower initial mortality/graft failure.
• Observed differences may be due to favorable patient selection for simultaneous procedures.
• Adjusted analyses indicate equivalent long-term survival between simultaneous and staged HKTx.