Cross-Organ Survival in Patients Undergoing Multi-Organ Cardiac Transplantation

Abstract

<h3>Purpose</h3> Multi-organ cardiac (i.e., heart-X) transplantation indications have increased as analyses suggest comparable outcomes to patients undergoing single-organ procedures. Here, we present a comparison between survival outcomes in three of the most prevalent multi-organ procedures: heart-lung, heart-kidney, and heart-liver transplantation. <h3>Methods</h3> Using the United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research Database, we retrospectively reviewed heart transplants performed from January 1988 to September 2020. Heart-pancreas and triple-organ transplants were excluded due to insufficient sample size. Survival was assessed with Kaplan-Meier method and compared by log-rank test. Univariate and multivariate cox regression analyses were performed to assess hazard ratios. <h3>Results</h3> A total of 80,058 patients were included in this study. Heart-lung transplant recipients experienced significantly worse survival compared to those receiving heart-kidney, heart-liver, or heart-only transplants (p <0.0001). Cox regression analyses found an increased risk for mortality in heart-lung transplants, HR 1.91 (95% CI 1.79-2.04, p <0.001). Multivariate analysis adjusting for donor age, recipient age, and ethnicity found increased risk for mortality in heart-lung transplants and reduced risk in heart-kidney transplants, HR 2.15 (95% CI 2.01-2.29, p <0.001) and HR 0.86 (95% CI 0.8-0.93, p <0.001), respectively. Higher donor or recipient age and African American ethnicity were associated with worse outcomes. <h3>Conclusion</h3> Patients undergoing heart-lung transplantation have poorer outcomes, while heart-liver and heart-kidney transplants display improved rates of survival relative to heart-only transplants. Further research should be performed to validate these findings prospectively and account for confounding.