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Survival Benefit of Heart-Kidney Versus Heart Transplant With or Without Delayed Kidney Transplant
Shin Yajima1,2, Hao He1, Stefan Elde1,2
1Department of Cardiothoracic Surgery Stanford University Stanford CA.
Insights
Simultaneous heart-kidney transplantation (SHKT) offers better long-term survival than isolated heart transplantation (IHT) for select patients with heart and kidney failure. Risk factors for needing a kidney transplant after IHT were also identified.
Area of Science:
- Cardiology
- Nephrology
- Transplantation Medicine
Background:
- Simultaneous heart-kidney transplantation (SHKT) and isolated heart transplantation (IHT) are options for patients with end-stage heart disease and kidney dysfunction.
- Clinical decisions can be improved by understanding outcomes, risk factors for kidney transplantation post-IHT, and survival benefits of SHKT versus IHT and kidney-after-heart transplantation.
Purpose of the Study:
- Evaluate outcomes of IHT.
- Identify risk factors for post-IHT isolated kidney transplantation.
- Compare survival benefits of IHT, SHKT, and kidney-after-heart transplantation.
Main Methods:
- Retrospective analysis of the United Network for Organ Sharing database (2000-2022).
- Included adult patients undergoing first IHT (n=48,069) or SHKT (n=2,345).
- Kaplan-Meier analysis and Cox proportional hazards model for survival; logistic regression for risk factors.
Main Results:
- Recipient age, BMI, pre-IHT diabetes, prior dialysis, and eGFR were risk factors for post-IHT kidney transplantation.
- SHKT showed significantly higher survival than IHT (1-year, 5-year, 10-year).
- SHKT demonstrated lower short-term but higher long-term survival compared to kidney-after-heart transplantation.
Conclusions:
- Selected patients with combined heart and kidney failure benefit from SHKT over IHT.
- SHKT provides superior long-term survival for specific patient groups.
Background:
Simultaneous heart-kidney transplantation (SHKT) or isolated heart transplantation (IHT) benefits patients with end-stage heart disease and kidney dysfunction. Understanding the outcomes, risk factors for post-IHT kidney transplantation, and survival benefits of SHKT compared with those of IHT and kidney-after-heart transplantation can guide clinical decision-making. This study aimed to evaluate IHT outcomes, identify risk factors for post-IHT isolated kidney transplantation, and compare the survival benefits of IHT, SHKT, and kidney-after-heart transplantation.
Methods:
This retrospective study analyzed data from the United Network for Organ Sharing database, spanning 2000 to 2022. Adult patients (aged ≥18 years) who underwent their first IHT (n=48 069) or SHKT (n=2345) were included. Among patients undergoing IHT, 667 (1.4%) subsequently received isolated kidney transplantation. The primary outcome was patient survival, which was visualized by Kaplan-Meier analysis and assessed using the shared-frailty Cox proportional hazards model. Survival rates were compared among IHT, SHKT, and kidney-after-heart transplantation recipients. Logistic regression analysis identified risk factors for post-IHT isolated kidney transplantation.
Results:
The recipient's age, body mass index, pre-IHT diabetes, prior dialysis, and estimated glomerular filtration rate were significant risk factors for post-IHT isolated kidney transplantation. Kaplan-Meier analysis showed significantly higher survival with SHKT than with IHT (1-year: 88.0% versus 85.7%; 5-year: 70.5% versus 64.1%; 10-year: 38.1% versus 30.3%; overall P=0.005). Compared with kidney-after-heart transplantation, SHKT tended to show lower short-term survival but higher long-term survival (5-year: 72.1% versus 61.9%, P=0.047; 10-year: 42.9% versus 15.8%, P<0.001).
Conclusions:
Selected patients with end-stage heart disease and kidney dysfunction derive more long-term survival benefit from SHKT than from IHT.
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