Outcomes following simultaneous heart-kidney vs heart ± delayed kidney transplantation

Results from a retrospective study of data from the United Network for Organ Sharing (UNOS), evaluating outcomes following isolated heart transplantation (IHT; n = 48,069), simultaneous heart-kidney transplantation (SHKT; n = 2,345), or kidney-after-heart transplantation (KAH; n = 667), were published in the Journal of the American Heart Association by Yajima et al. The primary outcome was post-transplant survival. 

Key data: Survival rates were higher in patients who received SHKT vs IHT (1‑year, 88.0% vs 85.7%; 5‑year, 70.5% vs 64.1%; 10‑year, 38.1% vs 30.3%; overall p = 0.005). Compared with KAH, SHKT was associated with lower short-term survival (1‑year, 86.6% vs 94.4%; p = 0.002) but higher long-term survival (5‑year, 72.1% vs 61.9%; p = 0.047; 10‑year, 42.9% vs 15.8%; p < 0.001). Prior dialysis (odds ratio [OR], 2.264), younger recipient age (OR, 0.879), pre-IHT diabetes (OR, 1.361), higher body mass index (BMI; OR, 0.979), and lower estimated glomerular filtration rate (eGFR; OR, 1.449) were identified as risk factors for post‑IHT isolated kidney transplantation (IKT). 

Key learning: SHKT may improve long-term survival compared with IHT or KAH, supporting its consideration as an upfront transplantation strategy in selected patients.