It is well known that chronic kidney disease has significant negative impact on post-transplant survival in heart transplant (HTx) recipients. Here we wanted to evaluate the impact of pre-transplant dialysis on HTx patient and ESRD-free survival. Methods: We identified 1301 HTx recipients who were more than 18 years of age and required pre-transplant dialysis from the United Network for Organ Sharing database between 1/2000-12/2015. The data was analyzed using non-competing risk Cox proportional hazards model for patient and ESRD-free survival. The adjusted models included age, gender, ethnicity, body mass index, cause of heart failure, diabetes, LVAD usage, and pre-transplant ECMO. Results: Of 1301 individuals on dialysis prior to transplant, 822 (63%) that received a HTx alone (HTA) while 479 (37%) received a simultaneous heart/kidney transplant (SHK). In this cohort, 423 died during the study period while 220 developed ESRD or received a kidney transplant. SHK recipients were older, more likely to be African-American and male. Those who received HTA were associated with lower patient survival (aHR 0.62, 95% CI 0.50-0.77) and ESRD-free survival (aHR 0.54, 95% CI 0.40-0.74).

The proportion of HTx recipients receiving both heart and kidney is increasing over time. Conclusion: Dialysis pre-HTx is a significant risk factor for poor patient survival and post-transplant ESRD. Although the rate of SHK is increasing, there is a large proportion of individuals who could benefit from SHK but are receiving HTA. Further investigation is required to optimize kidney allocation in HTx patients to improve overall survival.

CITATION INFORMATION: Akkina S., Desai A., Yoo J., Hou S., Parasuraman R. Impact of Pre-Transplant Dialysis on ESRD-Free and Patient Survival in Heart Transplant Alone and in Simultaneous Heart/Kidney Transplant Recipients: UNOS Data Analysis Am J Transplant. 2017;17 (suppl 3).

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