Combined Heart–Kidney Compared to Isolated Heart Transplant in Patients with Chronic Kidney Disease – A Single Center Experience
Tufts University School of Medicine, Boston, MA.
Meeting: 2018 American Transplant Congress
Abstract number: B62
Keywords: Graft function, Graft survival, Heart transplant patients, Kidney transplantation
Session Information
Session Name: Poster Session B: Heart and VADs: All Topics
Session Type: Poster Session
Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Background:
Severe irreversible renal dysfunction has been a contraindication for heart transplant (HTx); however, combined heart-kidney transplant (HKTx) is an accepted therapeutic option for concomitant end stage heart and renal disease. Studies have compared the two modalities but data on HKTx versus HTx recipients with reduced GFR is sparse.
Methods:
We conducted a retrospective analysis comparing HTx recipients with GFR <45 ml/min/1.73 (Group 1, N = 32) to HKTx recipients (Group 2, N = 16) performed between January 2007 and June 2017 at a single center. Analysis was performed using SPSS version 23 (Chicago, IL).
Results:
Mean age was 59 and 54 years (p = 0.12) respectively, majority were male and caucasian. Other baseline characteristics are shown in Table 1.
| Baseline Characteristics | |||
| Group 1 (HTx) | Group 2 (HKTx) | P Value | |
| Ischemic Heart Disease- n (%) | 12 (37) | 8 (50) | 0.54 |
| LVEF- mean (SD) | 12.6 (4.4) | 16.8 (7.7) | 0.05 |
| MCSD- n (%) | 26 (81) | 7 (44) | 0.02 |
| Inotrope dependent- n (%) | 16 (50) | 13 (81) | 0.06 |
| Dialysis- n (%) | 2 (6) | 9 (56) | <0.001 |
| Baseline GFR excluding subjects on dialysis- mean (SD) | 34.5 (7) | 25.9 (3.6) | 0.003 |
| Pump Time- mean (SD) | 196.6 (38.4) | 183.1 (36) | 0.22 |
| Cardiac Ischemic Time- mean (SD) | 198.8 (52.8) | 191.2 (28.4) | 0.58 |
Survival analysis evaluating cardiac allograft rejection and patient survival showed no significant difference in the 2 groups, but a trend towards lower rejection in Group 2.
| Outcomes | |||
| Group 1 (HTx) | Group 2 (HKTx) | P Value | |
| GFR Month 6- mean (SD) | 37.4 (13.5) | 58.9 (19.6) | 0.002 |
| GFR Year 1- mean (SD) | 45.7 (16.6) | 57.9 (20.7) | 0.18 |
| Median Follow Up (f/u)- days (interquartile range) | 748 (1151) | 882 (1929) | 0.76 |
| Mortality over f/u time- % | 16 | 31 | 0.14 |
| Rejection over f/u time- % | 38 | 19 | 0.32 |
| Hospital Length of Stay- mean (SD) | 20.6 (11.8) | 27.6 (23.3) | 0.17 |
Conclusion:
HTKx provides similar patient and graft survival, lower cardiac rejection and higher GFR as compared to HTx in patients with reduced kidney function. The question of ideal GFR cut-off for combined heart-kidney transplantation needs further study.
CITATION INFORMATION: Gauvin D., Bhalla A., McCallum W., Vest A., Goyal N. Combined Heart–Kidney Compared to Isolated Heart Transplant in Patients with Chronic Kidney Disease – A Single Center Experience Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Gauvin D, Bhalla A, McCallum W, Vest A, Goyal N. Combined Heart–Kidney Compared to Isolated Heart Transplant in Patients with Chronic Kidney Disease – A Single Center Experience [abstract]. https://atcmeetingabstracts.com/abstract/combined-heart-kidney-compared-to-isolated-heart-transplant-in-patients-with-chronic-kidney-disease-a-single-center-experience/. Accessed November 23, 2024.« Back to 2018 American Transplant Congress