Background. This study evaluated the management of immunosuppressive therapy and the incidence of acute heart rejection within 1 year from concomitant heart-kidney transplantation (cHTKx) compared to isolated heart transplant (HTx).

Methods.The United Network for Organ Sharing database was queried for cHKTx and HTx from January 2004 to June 2015. Immunosuppressive therapy data at time of surgery was compared between cHKTx and HTx. Recipients were compared for tacrolimus-based vs. cyclosporine-based immunosuppressive therapies. Incidence of acute heart rejection within 1 year requiring treatment was evaluated between cHKTx and HTx and stratified by different maintenance therapies.

Results. A total of 631 patients received cHKTx (female 20%) and 24099 received HTx (female 28%). In cHKTx group induction therapy with anti-lymphocyte drugs was used in 66% vs. 50% in HTx group (p<0.001). Tacrolimus-based maintenance therapy was used in 93% of cHKTx patiens vs. 78% of HTx patients (p<0.001). Other respective maintenance therapies in cHKTX and HTx groups were steroids (93% vs 87%, p=0.002) and mycophenolate mofetil (76% vs 76%, p=0.8). Incidence of patients treated for heart rejection during 1^st year was significantly lower in cHKTX recipients 8.6% (9% female) compared to 22% in HTx (26% female) recipients. Rejection stratified by gender showed no differences in cHKTx group (9% vs 8%, p=0.8) whereas females had higher rejection in HTx group compared to males (27% vs 20%, p<0.001) within 1^st year. Tacrolimus-based maintenance therapy (8.4%) reduced heart rejection during 1^st year when compared to cyclosporine (12%, p<0.001) in cHKTx.

Conclusions. For combined heart and kidney transplants steroids, mycophenolate and tacrolimus are most commonly used for maintenance. Combined heart and kidney transplants have significantly lower heart rejection during 1^st year of transplant compare to isolated heart transplant.

CITATION INFORMATION: Gallo M, Trivedi J, Abramov D, Vijayakrishnan R, Slaughter M. Immunosuppressive Therapy and Acute Rejection in Combined Heart and Kidney Transplantation. Am J Transplant. 2017;17 (suppl 3).

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