Renal Outcomes Following Simultaneous Heart-Kidney Transplant Compared with Heart Transplant Alone

Abstract

<h3>Purpose</h3> Acute renal dysfunction and chronic kidney disease (CKD) are frequent complications of advanced heart failure. Post-heart transplant (HT) renal injury is common and is precipitated by intra-operative volume shifts and prolonged exposure to calcineurin inhibitors, impacting patient survival and quality of life. Our aim was to compare renal outcomes among simultaneous heart-kidney transplant (HKT) and HT recipients. <h3>Methods</h3> This is a single-center, retrospective cohort study of HKT and HT recipients between 01/2012 and 06/2020 who had pre-transplant CKD3 or worse. The primary endpoint was change in estimated glomerular filtration rate (eGFR) from baseline to 12 months post-transplant, using the Modification of Diet in Renal Disease (MDRD) equation. Secondary endpoints included biopsy-proven acute rejection (BPAR), patient survival, and cytomegalovirus (CMV) infection. <h3>Results</h3> 12 HKT and 51 HT recipients were included. Baseline demographics and clinical outcomes are included in Table 1. There were significant differences between groups in heart failure etiology, induction therapy, and baseline renal function. There were no differences in maintenance immunosuppression. The change in eGFR from baseline to 12 months post-transplant was +24.2 mL/min/1.73m² for the HKT group and -3 mL/min/1.73m² for the HT group (p=0.002). There was no difference in BPAR, CMV viremia or patient survival. <h3>Conclusion</h3> HKT appears to offer improved renal function for patients with baseline CKD3, with similar patient and graft outcomes compared to HT alone. HT alone does not appear to facilitate renal recovery in CKD3 patients.