Contemporary immunosuppression practices in simultaneous heart–kidney transplantation

A United Network for Organ Sharing (UNOS) registry analysis, evaluating contemporary immunosuppression practices and associated outcomes in adult simultaneous heart–kidney transplant (SHKT) recipients (N = 2,634), was published in Pharmacotherapy by Huang et al. The study included patients transplanted between January 2013 and June 2024, with 1-year follow-up available through June 2025. One-year outcomes included treated rejection, graft failure, hospitalization for infection, and mortality. 

Key data: T-cell-depleting agents remained the most frequently used induction strategy (41.3%), followed by basiliximab (36.8%) and no induction (21.9%). Following the 2018 allocation policy change, basiliximab use increased (27% to 41%), while anti-thymocyte globulin (ATG) use declined (50% to 37%). Most patients received tacrolimus (95.1%), mycophenolate (94.8%), and corticosteroids (90.5%) at discharge; at 1 year, tacrolimus remained the most common maintenance immunosuppressant (79.5%). At 1 year post-transplant, 81.5% of patients were being treated with ≥2 immunosuppressants. Rates of treated rejection, hospitalization for infection, graft failure, and survival at 1 year were comparable across induction strategies. 

Key learning: Contemporary immunosuppression practices in SHKT have shifted toward increased basiliximab use while maintaining tacrolimus-based multidrug regimens. Comparable 1-year outcomes across induction strategies support further evaluation of individualized immunosuppression approaches in SHKT recipients.