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Updated: May 23, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
10-Year Survival and Renal Outcomes After Simultaneous Heart-Kidney Transplantation in Heart Retransplant Recipients
Ameesh Isath1, Naoki Tadokoro2, Felix Schoenrath3
1Mass General Brigham Heart and Vascular Institute, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Simultaneous heart-kidney transplantation (SHKT) improves 10-year survival for heart retransplant candidates with severe kidney dysfunction. This dual-organ approach offers better outcomes and renal trajectories compared to isolated heart retransplantation.
Area of Science:
- Cardiology
- Nephrology
- Transplantation Medicine
Background:
- Renal dysfunction is a significant challenge for heart retransplant candidates, impacting post-transplant outcomes.
- The long-term benefits of simultaneous heart-kidney transplantation (SHKT) in the re-HT setting are not well-established.
Purpose of the Study:
- To compare 10-year survival and renal function trajectories between SHKT and isolated heart retransplantation (re-HT).
- To identify patient subgroups that benefit most from SHKT in the re-HT context.
Main Methods:
- Analysis of adult re-HT recipients (2000-2024) from the UNOS registry, categorized into isolated re-HT and re-SHKT groups.
- Primary outcome: 10-year survival. Secondary outcomes: renal function, rejection rates, and cardiac allograft vasculopathy.
- Multivariable Cox regression and Fine-Gray competing risk models were employed for adjusted analyses.
Main Results:
- SHKT recipients (304/1,378) showed improved 10-year survival (71.2% vs. 59.1%) despite worse baseline renal function.
- Survival benefit was significant for patients with pre-transplant eGFR <45 mL/min/1.73 m², but not for those with eGFR ≥45 mL/min/1.73 m².
- Re-SHKT reduced subsequent kidney transplantation by 84% and decreased treated rejection episodes.
Conclusions:
- SHKT provides a sustained 10-year survival advantage and better renal outcomes in heart retransplant recipients, especially those with moderate to severe renal dysfunction.
- Dual-organ allocation (SHKT) should be considered for selected re-HT candidates with significant renal impairment.
Background:
Renal dysfunction is common in heart retransplant (re-HT) candidates and adversely influences outcomes. Although simultaneous heart-kidney transplantation (SHKT) is established in primary transplantation for severe renal dysfunction, its long-term benefit in the re-HT setting remains incompletely defined.
Objectives:
This study sought to evaluate 10-year survival and renal trajectories after SHKT compared with isolated re-HT.
Methods:
Adult patients undergoing re-HT (2000-2024) were identified from the UNOS (United Network for Organ Sharing) registry and categorized as isolated re-HT or simultaneous heart-kidney retransplantation (re-SHKT). The primary outcome was 10-year survival. Secondary outcomes evaluated renal outcomes, rejection, and cardiac allograft vasculopathy. Multivariable Cox regression and Fine-Gray competing risk models were used to adjust for recipient, donor, and era-related covariates.
Results:
Among 1,378 re-HT recipients, 304 (22%) underwent re-SHKT. Despite worse baseline renal function, re-SHKT was associated with improved 10-year survival (71.2% vs 59.1%, respectively; adjusted HR: 0.51; 95% CI: 0.38-0.70; P < 0.001). Survival benefit was observed in recipients with a pretransplant estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2 but not in those recipients with eGFR ≥45 mL/min/1.73 m2. Isolated re-HT recipients with baseline renal impairment (eGFR <45 mL/min/1.73 m2) demonstrated a graded increase in subsequent kidney transplantation and death before rescue transplantation. Re-SHKT was associated with an 84% reduction in subsequent kidney transplantation and fewer treated rejection episodes.
Conclusions:
In re-HT recipients, SHKT was associated with sustained 10-year survival benefit and favorable renal trajectories, particularly in patients with moderate to severe renal dysfunction. These findings support dual-organ allocation in selected re-HT candidates with moderate to severe renal dysfunction.
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