Cardiac Outcomes in Isolated Heart and Simultaneous Kidney and Heart Transplants in the US

K. A. Agarwal¹, H. Patel¹, N. Agrawal¹, F. Cardarelli¹, N. Goyal²

¹Nephrology, Beth Israel Deaconess Medical Center, Boston, MA, ²Nephrology, Tufts Medical Center, Boston, MA

Meeting: 2021 American Transplant Congress

Abstract number: 624

Keywords: Heart transplant patients, Kidney transplantation, Outcome, Survival

Topic: Clinical Science » Biomarkers, Immune Assessment and Clinical Outcomes

Session Information

Session Name: Biomarkers, Immune Assessment and Clinical Outcomes

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Kidney dysfunction is not uncommon in patients with advanced heart failure. Simultaneous kidney and heart transplants (SKHT) have gained acceptance as treatment for patients with end-stage heart failure (ESHF) and severe kidney dysfunction. US saw a rise of 650% in SKHT from 2000 to 2019. Despite increasing number of SKHT, the selection criteria remain poorly defined and vary across transplant centers. We wanted to identify heart transplant candidates who may benefit from a simultaneous kidney-heart transplant.

*Methods: In this retrospective cohort study, we examined the patient and cardiac allograft survival for SKHT and heart transplant alone (HTA) recipients between 1987 and 2019 using the United Network for Organ Sharing (UNOS) database. We then performed a subgroup analysis in recipients with post-transplant Acute Kidney Injury (AKI) requiring renal replacement therapy (RRT) and compared outcomes between SKHT and HTA recipients.

*Results: A total of 61,410 HTA and 1,507 SKHT recipients were included in the final analysis. While patient survival was comparable between SKHT and HTA groups (12.4 vs. 11.3 years), pretransplant dialysis-dependent patients derived a significant survival benefit from SKHT (12.4 years vs. 9.9 years). Cardiac graft survival was better in SKHT (12.5 vs. 11.2 years). Age less than 30 years (OR 1.27), higher BMI (OR 1.02), reduced GFR (OR 9.46 for GFR<30, OR 2.68 for 30-44, OR 1.99 for GFR 45-59), mechanical cardiac support (OR 1.28), recipient diabetes (OR 1.15), inotropic support (OR 1.11) and prior sternotomy (OR 1.61) were significant risk factors for AKI requiring dialysis post-transplant. Among these patients, SKHT recipients had a significantly better survival as compared to HTA recipients (11.9 vs. 2.7 years).

*Conclusions: Our data supports consideration of SKHT in dialysis-dependent heart transplant candidates and suggests that patients who are at increased risk of requiring RRT post heart transplant may also benefit from SKHT.

To cite this abstract in AMA style:

Agarwal KA, Patel H, Agrawal N, Cardarelli F, Goyal N. Cardiac Outcomes in Isolated Heart and Simultaneous Kidney and Heart Transplants in the US [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/cardiac-outcomes-in-isolated-heart-and-simultaneous-kidney-and-heart-transplants-in-the-us/. Accessed May 11, 2025.

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