Need for Improvements in Simultaneous Heart Kidney Allocation: The Limitation of Pretransplant Glomerular Filtration Rate.
The incidence of simultaneous kidney heart transplant (SHK) has increased markedly in the last 15 years. There are no universally agreed upon indications for SHK vs. heart alone (HA) transplant, and center evaluation processes vary widely. We utilized Scientific Registry of Transplant Recipients data from 2003-2017 to quantify changes in the practice of SHK, examine the survival of SHK vs. HA, and identify patients with marginal benefit from SHK. We used Kaplan-Meier curves and Cox proportional hazards to assess differences in survival. The incidence of SHK increased more than four-fold between 2003 and 2017 from 1.6% to 6.6% of total hearts transplanted, while the proportion of dialysis-dependent patients undergoing SHK has remained constant. SHK was associated with increased survival in dialysis-dependent patients (Median Survival SHK: 12.6 vs. HA: 7.1 years p<0.0001) but not non-dialysis-dependent patients (Median Survival SHK: 12.5 vs. HA 12.3, p=0.24). The marginal effect of SHK in decreasing the hazard of death diminished with increasing eGFR. Delayed graft function occurred in 26% of SHK recipients. Post-transplant chronic dialysis was similar for both operations (6.4% of HA and 6.0% of SHK). Further study is needed to define patients that benefit from SHK.
Shaw, Brian I., Mariya L. Samoylova, Scott Sanoff, Andrew S. Barbas, Debra L. Sudan, L Ebony Boulware, and Lisa M. McElroy. “Need for Improvements in Simultaneous Heart Kidney Allocation: The Limitation of Pretransplant Glomerular Filtration Rate.” Am J Transplant, December 22, 2020. https://doi.org/10.1111/ajt.16466.