Background: Increasing numbers of patients with advanced heart and kidney failure undergo simultaneous heart kidney transplant (SHK). Selection criteria in patients with non-dialysis dependent kidney failure are not well defined and vary by center. Our transplant center has a dedicated heart-kidney transplant listing team that standardizes selection criteria and evaluation for SHK. We employ a “watchlist” to monitor patients who do not meet criteria but have pre-defined high risk features for progression of renal disease. We report outcomes of our multidisciplinary approach to triage this complex patient population.

Methods: Retrospective review of patients referred for SHK from 2009 to 2015 was conducted. Patient demographics, clinical comorbidities, and markers of cardiac and renal function were collected. Patients were evaluated based on the algorithm shown in figure 1. Numbers of patients evaluated, listed for dual organ or single organ transplant, or placed on the watchlist were recorded. Outcomes including successful transplantation and waitlist mortality were noted.

Results: Of 51 patients referred for SHK, 30 were declined due to psychosocial or medical co-morbidities. Of the remaining, 13 were listed for SHK, 7 placed on the watchlist, and 1 met criteria for heart transplant alone(HTA). There were no differences in age, gender distribution, eGFR, EF or cause of renal disease between patients listed for SHK and the watchlist. More SHK listed patients had ischemic cardiomyopathy and were dialysis dependent. One watchlist patient ultimately underwent SHK and 3 HTA. One watchlist patient died, compared to 5 listed for SHK.

Conclusions: Simultaneous HKT benefits specifically targeted patients with advanced heart and kidney failure. An integrated approach with the ability of closely monitor high risk patients, allowed for identification of the patient subset who are candidates for HTA instead of SHK.

CITATION INFORMATION: Fonseka N, Mangrolia H, Karhadkar S, Rao S, Punnoose L. Simultaneous Heart and Kidney Transplant vs Heart Transplant: Single Center Review of Candidate Selection and List Management. Am J Transplant. 2017;17 (suppl 3).

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