Contemporary Immunosuppression in Simultaneous Heart-Kidney Transplantation: A United Network for Organ-Sharing...

Simultaneous heart-kidney transplantation (SHKT) has become increasingly common over the past decade, accompanied by evolving recipient characteristics and outcomes introduced by the 2018 United Network for Organ Sharing (UNOS) heart allocation policy change. However, contemporary data on immunosuppression practices in SHKT recipients remain limited. To address these knowledge gaps, this study characterizes contemporary immunosuppression practices in SHKT recipients and evaluates their association with post-transplant outcomes.

This UNOS registry analysis included adult SHKT recipients from January 2013 to June 2025. We evaluated induction and maintenance immunosuppression strategies and 1-year outcomes including treated rejection, graft failure, infection, and mortality. Among 2634 recipients, T-cell depleting agents remained the most used induction strategy (41.3%), followed by basiliximab (36.8%) and no induction (21.9%). Basiliximab use increased post-2018, while anti-thymocyte globulin use declined. mTOR inhibitor use at 1 year was highest among patients receiving T-cell depleting agents. Despite these shifts, adjusted analyses showed no significant differences in 1-year rejection, graft failure, or mortality across induction groups.

Contemporary SHKT recipients experience similar 1-year outcomes across induction strategies. Basiliximab may be sufficient for standard-risk SHKT recipients.