(496) - Combined Kidney Transplant in Patients Needing Redo Heart Transplant: Viable Option?

Abstract

PurposePatients who undergo heart transplant are at risk for graft dysfunction (usually due to cardiac allograft vasculopathy (CAV)), which may require re-transplant. It is also not uncommon for heart transplant patients to develop severe kidney damage from the CNI or from pre-existing kidney ailments. These patients who require redo heart transplant may also need an additional simultaneous kidney transplant from the same donor. It has not been established whether these patients needing redo heart transplant with simultaneous de novo kidney transplantation have acceptable outcomes.MethodsBetween 1997 and 2011, we evaluated 1017 heart transplant patients. Patients with redo heart transplants and an additional kidney transplant (n=7) were compared to patients with de novo heart transplant alone (n=974) and de novo heart/kidney transplant (n=36). Outcomes included 3 year actuarial survival, freedom from CAV, and freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, ICD/pacemaker implant, stroke). 1-Year freedom from any treated rejection, both cellular and antibody mediated, was also assessed.ResultsThere was no significant difference between the redo heart de novo kidney transplant group and the two other groups for post-transplant outcomes. (See table)Tabled 1De Novo Heart Only (n=974)De Novo Heart/Kidney (n=36)Redo Heart De Novo Kidney (n=7)3-Year Actuarial Survival88.1%82.8%85.7%3-Year Actuarial Freedom from CAV83.9%86.8%100.0%3-Year Actuarial Freedom from NF-MACE88.1%87.1%100.0%1-Year Freedom from Any Treated Rejection85.8%88.1%100.0%1-Year Freedom from Treated Cellular Rejection92.2%97.1%100.0%1-Year Freedom from Treated Antibody-Mediated Rejection94.0%97.1%100.0%P=NS for all pairwise comparisons Open table in a new tab ConclusionRedo heart transplants with de novo kidney transplants have acceptable outcomes. Therefore, severe renal disease in patients who require redo heart transplants should not be a contraindication to this surgery. PurposePatients who undergo heart transplant are at risk for graft dysfunction (usually due to cardiac allograft vasculopathy (CAV)), which may require re-transplant. It is also not uncommon for heart transplant patients to develop severe kidney damage from the CNI or from pre-existing kidney ailments. These patients who require redo heart transplant may also need an additional simultaneous kidney transplant from the same donor. It has not been established whether these patients needing redo heart transplant with simultaneous de novo kidney transplantation have acceptable outcomes. Patients who undergo heart transplant are at risk for graft dysfunction (usually due to cardiac allograft vasculopathy (CAV)), which may require re-transplant. It is also not uncommon for heart transplant patients to develop severe kidney damage from the CNI or from pre-existing kidney ailments. These patients who require redo heart transplant may also need an additional simultaneous kidney transplant from the same donor. It has not been established whether these patients needing redo heart transplant with simultaneous de novo kidney transplantation have acceptable outcomes. MethodsBetween 1997 and 2011, we evaluated 1017 heart transplant patients. Patients with redo heart transplants and an additional kidney transplant (n=7) were compared to patients with de novo heart transplant alone (n=974) and de novo heart/kidney transplant (n=36). Outcomes included 3 year actuarial survival, freedom from CAV, and freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, ICD/pacemaker implant, stroke). 1-Year freedom from any treated rejection, both cellular and antibody mediated, was also assessed. Between 1997 and 2011, we evaluated 1017 heart transplant patients. Patients with redo heart transplants and an additional kidney transplant (n=7) were compared to patients with de novo heart transplant alone (n=974) and de novo heart/kidney transplant (n=36). Outcomes included 3 year actuarial survival, freedom from CAV, and freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, ICD/pacemaker implant, stroke). 1-Year freedom from any treated rejection, both cellular and antibody mediated, was also assessed. ResultsThere was no significant difference between the redo heart de novo kidney transplant group and the two other groups for post-transplant outcomes. (See table) There was no significant difference between the redo heart de novo kidney transplant group and the two other groups for post-transplant outcomes. (See table) ConclusionRedo heart transplants with de novo kidney transplants have acceptable outcomes. Therefore, severe renal disease in patients who require redo heart transplants should not be a contraindication to this surgery. Redo heart transplants with de novo kidney transplants have acceptable outcomes. Therefore, severe renal disease in patients who require redo heart transplants should not be a contraindication to this surgery.