Session Time: 7:30pm-8:30pm
Presentation Time: 7:30pm-7:40pm
*Purpose: In the United States, heart allograft allocation is a primary determinant for heart-kidney transplantation (HKT). We analyzed the OPTN dataset and compared the outcomes of HKT performed under the prior heart allocation system (prior-HAS, October 1, 2015-October 18, 2018, n= 516) and the current-HAS which prioritized sicker patients (after October 18, 2018, n=149)).
*Methods: We acquired de-identified data from the OPTN registry with follow up through December 6, 2019.Baseline demographics, comorbidities, etiology of cardiac and kidney dysfunction were collected. Pre-transplant cardiac support was assessed by inotropic and/or mechanical circulatory support (MCS). The kidney dysfunction pre-transplant was assessed by the serum creatinine at listing, the need for pre-transplant dialysis, and duration of dialysis (short ≤6 weeks, medium 7-12, long >12 weeks).
*Results: Under the current-HAS, the percentage of HKT amongst the total heart transplants has increased to 6.4% from 5.3% (p=0.038). Although the prevalence of pre-transplant dialysis was similar (about 50%) amongst the groups, a higher percentage in the current-HAS group had a short duration (less than 6 weeks) of dialysis (24.5% vs 7.3%, p= 0.01). On univariate Cox-regression, the current-HAS group had lower 180-day survival (87.2% vs 92.4%, HR 1.75, 95%CI 1.01-3.04, p=0.04) and a trend towards lower kidney allograft survival (83.9% vs 85.9%, HR 1.60, 95%CI 0.09-2.59, p= 0.05). After adjusting for covariates, HAS era was not an independent predictors of outcomes. Delayed graft function of kidney allograft remained a strong predictor of poorer outcomes and was higher in the current-HAS group (35% vs 26%, p=0.03).
*Conclusions: Our study shows that the rates of HKT have continued to increase under the current HAS. Similar to the higher mortality in heart transplant recipients under the current-HAS era, patient mortality was higher in the HKT recipients too. This study highlights the need for a novel HKT allocation policy with standardized listing and allocation criteria aimed to improve HKT outcomes.
To cite this abstract in AMA style:Rao S, Doyle A, Brennan D, Constantinescu S. Early Outcome of Heart-Kidney Transplantation in the Current Heart Allocation System in the United States [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/early-outcome-of-heart-kidney-transplantation-in-the-current-heart-allocation-system-in-the-united-states/. Accessed September 21, 2021.
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