Background: Combined Heart-Kidney Transplantation (CHKT) is the optimal therapy for patients with advanced renal dysfunction. Our aim was to analyze kidney specific graft outcomes in this unique population.

Methods: We analyzed UNOS database for all CHKT performed between Jan 2000 and Jun 2015.

Results: A total of 971 cases of CHKT were identified. 24% were performed during 2000-2005, 29.7% during 2006-2010, while 38.6% were performed during 2011-2015. 30.8% of recipients had ischemic vs 26.6% idiopathic cardiomyopathy. 69.4% were on life support at time of transplant.

38.8% were on dialysis at the time of transplant. 77% were males with 27.6% AA, 38.1% Diabetics, 59% ;left sided donor Kidneys, 2.7% pediatric recipients, 3.7% re-transplant candidates. Mean KDPI was 26.3+/-20% with only 0.8% >85 KDPI. Mean Cold Ischemia Time was 13.9+/-12 hours with majority (61.8%) of kidneys not pulsatile pump. Dialysis within first week was 24.8%. Mean heart ischemia time was 3.1+/-1.0 hours. 5.2% 1yr Acute Rejection Rate.

Graft Survival was significantly lower in those who had Dialysis within first week (OR 2.9 CI2.1-3.9 ;p<0.0005); those who were on dialysis at time of transplant (OR 1.68; p<0.005). Recipient DM (p=0.009) Donor Age (p=0.002), Higher KDPI was associated with lower graft survival (p=0.002)

There was no difference in pumped or ice kidneys versus those not pumped(p=0.710). Gender, Recipient Race, Recipient age, kidney cold ischemia time, heart ischemia time, Recipient or Donor BMI, Serum albumin, days on waiting list, donor terminal creatinine, were not associated with inferior graft survival, heart listing status, life support therapy (p=NS).

Immunosuppression was : Thymoglobulin (36.9%) ; IL2RA (31.4%); Steroid Induction (59.6%); Steroid Maintenance (88.5%), Cyclosporine(10.4%) Tacrolimus (82.0%), Mycophenolate (87.1%).Thymoglobulin induction was associated with higher graft survival (p=0.02) vs other or no induction use.

1yr, 3yr, 5yr Unadjusted Kidney Graft and Patient survival was 83%,78%,71% and 86%,80% 75% respectively. One-year conditional (patient survival atleast 1 yr) kidney graft survival were 98%,92% and 84% respectively. Death-censored kidney graft survival was 98%,97% and 95% respectively.

Conclusions: We describe in detail the outcomes in detail of kidney graft survival in CHKT and associated risk factors. Overall traditional risk factors remain the same, while graft survival primarily is affected by early patient survival.

CITATION INFORMATION: Riaz A., Adebiyi O., Mishler D., Yaqub M., Taber T., Sharfuddin A. Kidney Graft Outcomes in Combined Heart-Kidney Transplantation: A UNOS Database Analysis 2000-2015 Am J Transplant. 2017;17 (suppl 3).

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