Abstract
BackgroundIn spite of renal graft shortage and increasing waiting times for transplant candidates, simultaneous heart and kidney transplantation (HKTx) is an increasingly performed procedure established for patients with combined end-stage cardiac and renal failure. Although data on renal graft outcome in this setting is limited, reports on reduced graft survival in comparison to solitary kidney transplantation (KTx) have led to an ongoing discussion of adequate organ utilization.MethodsThis retrospective study was conducted to evaluate prognostic factors and outcomes of 27 patients undergoing HKTx in comparison to a matched cohort of 27 patients undergoing solitary KTx between September 1987 and October 2019 in one of Europe’s largest transplant centers.ResultsMedian follow-up was 100.33 (0.46–362.09) months. Despite lower five-year kidney graft survival (62.6% versus 92.1%; 111.73 versus 183.08 months; p = 0.189), graft function and patient survival (138.90 versus 192.71 months; p = 0.128) were not significantly inferior after HKTx in general. However, in case of prior cardiac surgery requiring sternotomy we observed significantly reduced early graft and patient survival (57.00 and 94.09 months, respectively) when compared to patients undergoing solitary KTx (183.08 and 192.71 months; p < 0.001, respectively) or HKTx without prior cardiac surgery (203.22 and 203.22 months; p = 0.016 and p = 0.019, respectively), most probably explained by the significantly increased rate of primary nonfunction (33.3%) and in-hospital mortality (25.0%).ConclusionsOur data demonstrates the increased rate of early kidney graft loss and thus significantly inferior graft survival in high-risk patients undergoing HKTx. Thus, we advocate for a “kidney-after-heart” program in such patients to ensure responsible and reasonable utilization of scarce resources in times of ongoing organ shortage crisis.
Highlights
In spite of renal graft shortage and increasing waiting times for transplant candidates, simultaneous heart and kidney transplantation (HKTx) is an increasingly performed procedure established for patients with combined end-stage cardiac and renal failure
We advocate for a “kidney-after-heart” program in such patients to ensure responsible and reasonable utilization of scarce resources in times of ongoing organ shortage crisis
In times of ongoing organ shortage, this data is alarming as the allocation of two organs to a single patient has to be justified with regard to patients awaiting heart transplantation (HTx), and to patients on the waiting list for KTx: Since kidney injury is frequently associated with end-stage heart failure and a growing number of patients experience prolonged waiting times for an appropriate cardiac transplant [8], concomitant demand of renal grafts for these patients is predictable, which will further diminish the availability of organs in the KTx allocation system [9]
Summary
In spite of renal graft shortage and increasing waiting times for transplant candidates, simultaneous heart and kidney transplantation (HKTx) is an increasingly performed procedure established for patients with combined end-stage cardiac and renal failure. In times of ongoing organ shortage, this data is alarming as the allocation of two organs to a single patient has to be justified with regard to patients awaiting HTx, and to patients on the waiting list for KTx: Since kidney injury is frequently associated with end-stage heart failure and a growing number of patients experience prolonged waiting times for an appropriate cardiac transplant [8], concomitant demand of renal grafts for these patients is predictable, which will further diminish the availability of organs in the KTx allocation system [9] This implicates socioeconomic ramifications and impairment of quality of life of potential recipients, and significantly decreases long-term survival of patients requiring renal replacement therapy [10,11,12]
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