Abstract

<h3>Purpose</h3> Rates of simultaneous heart kidney (SHK) transplant are increasing annually. SHK confers survival benefit in recipients with pre-transplant renal failure, but its role in renal failure patients bridged to transplant with continuous-flow ventricular assist devices (VADs) is not well defined. This study evaluates the utility of SHK vs. heart transplant alone (HTA) in this population. <h3>Methods</h3> Retrospective review of the Organ Procurement and Transplantation Network database was performed for adult heart transplant recipients. Renal failure was defined as pre-transplant dialysis or glomerular filtration rate <30 mL/min. VAD patients with renal failure were divided by SHK vs. HTA. Primary outcome was patient survival. Secondary non-survival outcomes included post-operative dialysis dependence. Regression analyses assessed SHK as a predictor of post-transplant survival. <h3>Results</h3> There were 125 SHK patients and 276 HTA. Baseline characteristics were largely similar. Patient survival up to 5 years was the same between SHK and HTA (HR: 0.98, p=0.94). 45.6% of SHK patients required dialysis postoperatively compared to 40.9% in HTA (p=0.39). Renal allograft survival in the SHK population was 83.7% vs. 92.1% in kidney transplant alone (p<0.01). Multivariable regression did not identify SHK as independently predictive of post-transplant patient survival. <h3>Conclusion</h3> SHK confers no survival advantage over HTA in VAD-supported patients in renal failure. Judicious use of SHK in this population may improve renal allograft utilization without affecting outcomes for heart transplant recipients.

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