Heart-kidney Transplantation Research Articles

Abstract 4136036: Five-year Outcomes of Heart-Kidney Transplant Recipients Bridged with Durable Mechanical Circulatory Support: Less AMR Better Survival?

Introduction: Despite the increased risk of sensitization in patients receiving pre-transplant durable mechanical circulatory support (D-MCS), it has been suggested that removing D-MCS at the time of transplant may lead to a drop in HLA-antibody levels. Whether this may reduce rejection rates and improve long-term outcomes in patients undergoing heart-kidney transplantation (HKTx) has not been widely investigated. Therefore, we aim to investigate the impact of pre-transplant D-MCS on 5-year clinical outcomes of patients undergoing HKTx. Methods: We included 98 patients undergoing HKTx between 2010 and 2018 at a single center. Recipient pre-transplant characteristics and clinical outcomes were compared between patients receiving D-MCS (n=24) versus non-D-MCS patients (n=74). The D-MCS cohort included those who received total artificial heart (n=13), left ventricular assist device (n=8), and biventricular assist devices (n=3). Endpoints included 1- and 5-year survival, 1-year-freedom from acute cellular rejection (defined as grade 2R or 3R), 1-year-freedom from antibody-mediated rejection (AMR, defined as pathologic AMR of grade ≥1), 5-year freedom from cardiac allograft vasculopathy (CAV, stenosis ≥30% by angiography), 5-year freedom from non-fatal major adverse cardiac events (NF-MACE including myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), and 5-year freedom from left ventricular dysfunction (LVEF ≤40). Results: At 1 year, freedom for AMR was numerically higher in the D-MCS group (100 vs. 90.2%, P=0.12). Additionally, the 5-year post-transplant survival rate was higher in the D-MCS group (95.8% vs. 80.8%), but it did not reach statistical significance (P=0.091). Comparable outcomes were noted for other outcomes, including 5-year freedom from CAV, NF-MACE, or LVD (Table 1 ). Conclusion: The current study hints at better 5-year survival in HTKx recipients receiving pre-transplant D-MCS, which could be attributed to lower rates of AMR in this population. Future larger studies are warranted to further validate these findings.

Outcomes of Multiorgan Heart Transplant Between Donation After Circulatory Death and Brain Death.

There is insufficient data on the outcomes of donation after circulatory death (DCD) multiorgan transplant that includes heart. The primary objective of this study is to compare the overall survival outcomes of DCD and donation after brain death (DBD) multiorgan transplants. We identified all heart transplant patients from 2019 to June of 2023 using the United Network for Organ Sharing (UNOS) Database who also received an additional organ (kidney, liver, and lungs). A total of 1,844 DBD and 91 DCD multiorgan transplants occurred within the study period, the majority being combined heart-kidney transplantation. More patients were listed at a higher status in the DBD group (p < 0.05) and were in the intensive care unit (ICU) before transplant (p < 0.05). Despite the higher ischemia time in the DCD group (p < 0.05), the overall unmatched survival did not differ between the two groups (p < 0.05). Within the heart-kidney transplants, the overall survival between DBD and DCD heart-kidney transplants did not differ in either unmatched or matched groups (unmatched p = 0.5, matched p = 0.5). In conclusion, the data on the outcomes of DCD multiorgan transplants are limited. Still, our analysis of the currently available data suggests that the overall survival is comparable in the DCD multiorgan transplants.

Ten hour donor heart ischemic time with 10ºC static storage

Utilization of 10ºC static storage safely extended both ischemic time and travel radius in heart transplantation. A 57-year-old man with ischemic cardiomyopathy, a left ventricular assist device (LVAD), and end-stage renal disease was listed for combined heart-kidney transplant. The donor hospital in Anchorage, AK, was located approximately 2,700 nautical miles and 8 hours from the recipient center. The organ was transported in 10ºC static storage with over 10 hours of ischemic time and had superb early allograft function. Excellent outcomes with extended ischemic times can be achieved without machine perfusion, provided good recovery, storage, and implant techniques are followed.

Simultaneous Heart-Kidney Transplant Is the Best Treatment Option for Patients with CKD and ESKD vs. Heart Transplant Alone

Simultaneous Heart-Kidney Transplant Is the Best Treatment Option for Patients with CKD and ESKD vs. Heart Transplant Alone

Assessing Kidney Function in Combined Heart-Kidney Transplant Candidates: Challenges and Opportunities

Assessing Kidney Function in Combined Heart-Kidney Transplant Candidates: Challenges and Opportunities

Investigation of Proteinuria in a Simultaneous Heart-Kidney Transplant Recipient with AL Amyloidosis

Investigation of Proteinuria in a Simultaneous Heart-Kidney Transplant Recipient with AL Amyloidosis

Management of heart disease in renal transplant recipients: a national Delphi survey-based SET/SEC/SEN consensus document

Renal transplantation improves the survival and quality of life of patients with end-stage renal disease. Cardiovascular disease is the leading cause of morbidity and mortality in renal transplant recipients. The bidirectional relationship between renal and heart disease creates a unique clinical scenario that demands a comprehensive and personalized approach. This expert consensus, drafted by the Spanish Society of Transplantation, the Spanish Society of Cardiology, and the Spanish Society of Nephrology, aims to assess current practices and propose strategies for the management of heart disease in renal transplant recipients. A panel of Spanish nephrologists and cardiologists with expertise in renal and heart transplantation reviewed the scientific evidence concerning the current management of heart disease in renal transplant recipients. Subsequently, consensus statements were created through a 2-round Delphi methodology, resulting in 30 statements covering key topics such as the identification of renal transplant candidates, the management of heart disease in renal transplant recipients, and eligibility for combined heart-kidney transplantation in patients with both end-stage renal disease and cardiac disease. These consensus statements provide expert guidance for the management of heart disease in renal transplant recipients, an area where published clinical evidence remains limited.

Decreased Risk for Rejection in Simultaneous Heart-Kidney Transplant

Decreased Risk for Rejection in Simultaneous Heart-Kidney Transplant

229: Pre-Transplant Short-Term Mechanical Circulatory Support Effects on Postoperative Kidney Function Outcomes Following Simultaneous Heart-Kidney Transplant

229: Pre-Transplant Short-Term Mechanical Circulatory Support Effects on Postoperative Kidney Function Outcomes Following Simultaneous Heart-Kidney Transplant

Increasing Multiorgan Heart Transplantations From Donation After Circulatory Death Donors in the United States.

Donation after circulatory death (DCD) donors are becoming an important source of organs for heart-transplantation (HT), but there are limited data regarding their use in multiorgan-HT. Between January 2020 and June 2023, we identified 87 adult multiorgan-HTs performed using DCD-donors [77 heart-kidney, 6 heart-lung, 4 heart-liver] and 1494 multiorgan-HTs using donation after brain death (DBD) donors (1141 heart-kidney, 165 heart-lung, 188 heart-liver) in UNOS. For heart-kidney transplantations (the most common multiorgan-HT combination from DCD-donors), we also compared donor/recipient characteristics, and early outcomes, including 6-month mortality using Kaplan-Meier (KM) and Cox hazards-ratio (Cox-HR). Use of DCD-donors for multiorgan-HTs in the United States increased from 1% in January to June 2020 to 12% in January-June 2023 (p < 0.001); but there was a wide variation across UNOS regions and center volumes. Compared to recipients of DBD heart-kidney transplantations, recipients of DCD heart-kidney transplantations were less likely to be of UNOS Status 1/2 at transplant (35.06%vs. 69.59%) and had lower inotrope use (22.08%vs. 43.30%), lower IABP use (2.60%vs. 26.29%), but higher durable CF-LVAD use (19.48%vs. 12.97%), all p < 0.01. Compared to DBD-donors, DCD-donors used for heart-kidney transplantations were younger [28(22-34) vs. 32(25-39) years, p=0.004]. Recipients of heart-kidney transplantations from DCD-donors and DBD-donors had similar 6-month survival using both KM analysis, and unadjusted and adjusted Cox-HR models, including in propensity matched cohorts. Rates of PGF and in-hospital outcomes were also similar. Use of DCD-donors for multiorgan-HTs has increased rapidly in the United States and early outcomes of DCD heart-kidney transplantations are promising.

Incidence and Risk Factors for Stroke After Combined Heart-Kidney and Heart-Liver Transplantation.

While stroke is a well-recognized complication of isolated heart transplantation, stroke in patients undergoing simultaneous heart-liver (HLT) and heart-kidney transplantation (HKT) has not been explored. This study assessed postoperative stroke incidence, risk factors, and outcomes in HLT and HKT compared with isolated heart transplant. The United Network for Organ Sharing database was queried for adult patients undergoing HLT, HKT, and isolated heart transplants between 1994 and 2022. Patients were stratified by presence of in-hospital stroke after transplant. Post-transplant survival at 1-year was assessed using Kaplan-Meier analysis and log-rank tests. Separate multivariable logistic regression models were constructed to identify risk factors for stroke after HKT and HLT. Of 2326 HKT recipients, 85 experienced stroke, and of 442 HLT recipients, 19 experienced stroke. Stroke was more common after HKT and HLT than after an isolated heart transplant (3.7% vs. 4.3% vs. 2.9%, p=0.01). One-year post-transplant survival was lower in those with stroke among both HKT recipients (64.5% vs. 88.7%, p(log-rank)<0.001) and HLT recipients (43.8% vs. 87.4%, p(log-rank)<0.001. Pre-transplant pVAD, prior stroke, postoperative dialysis, diabetes, prior cardiac surgery, and heart cold ischemic time were independent risk factors for stroke after HKT, after adjusting for age, sex, and need for blood transfusion on the waitlist. For HLT, postoperative dialysis was a significant risk factor. Stroke is more common after HKT and HLT than after isolated heart transplant, and results in poor survival. Independent risk factors for stroke include pre-transplant percutaneous VAD (HKT) and postoperative dialysis (HKT and HLT).

Kidney transplant outcomes in children with simultaneous versus sequential heart-kidney transplants.

Heart transplant recipients frequently require kidney transplantation for concomitant advanced chronic kidney disease. Data on simultaneous (heart and kidney transplants performed simultaneously) versus sequential (heart transplant performed before kidney) heart-kidney transplants in children are limited. Herein, we compare kidney transplant outcomes between the two groups. We used the Scientific Registry of Transplant Recipients to identify all pediatric (age <21 years) heart transplant recipients who also received a kidney transplant within 10 years of the heart transplant. We divided the study cohort into simultaneous heart-kidney and sequential heart-kidney recipients. We compared patient and death-censored graft survival using the Cox regression, adjusting for age at kidney transplant, sex, race, pre-transplant dialysis, donor type, and prior kidney transplant. We evaluated delayed graft function (defined as dialysis within the first week posttransplant) using logistic regression. Our analysis cohort included 165 recipients (86 simultaneous and 79 sequential). The incidence of delayed graft function was higher in simultaneous recipients (22.4 vs. 7.7%, p=0.017), but the difference lost statistical significance on multivariable analysis. We found no difference in patient survival (aHR 0.97; 95% CI 0.39, 2.41; p=0.95) after kidney transplant but higher death-censored kidney graft survival in sequential heart-kidney recipients compared with simultaneous heart-kidney recipients (aHR 4.26; 95% CI 1.21, 14.9; p=0.02). Sequential heart-kidney transplants are associated with higher death-censored kidney allograft survival in children compared with simultaneous heart-kidney transplants.

(746) - Size Matching in Combined Heart-Kidney and Heart-Liver Transplant: An Undersized Donor-Recipient Weight Ratio is Associated with Increased Mortality in Heart-Kidney Transplant

(746) - Size Matching in Combined Heart-Kidney and Heart-Liver Transplant: An Undersized Donor-Recipient Weight Ratio is Associated with Increased Mortality in Heart-Kidney Transplant

(743) - Does Racial Difference Affect Outcome After Heart-Kidney Transplantation?

(743) - Does Racial Difference Affect Outcome After Heart-Kidney Transplantation?

(1392) - Comparison of Basiliximab and Anti-Thymocyte Globulin as Induction Therapy for Simultaneous Heart-Kidney Transplantation in the Contemporary Era

(1392) - Comparison of Basiliximab and Anti-Thymocyte Globulin as Induction Therapy for Simultaneous Heart-Kidney Transplantation in the Contemporary Era

(537) - Comparative Outcomes of Simultaneous Heart-Kidney Transplantation from DBD and DDC-NRP Donors

(537) - Comparative Outcomes of Simultaneous Heart-Kidney Transplantation from DBD and DDC-NRP Donors

456 GFR assessment in Combined Heart-Kidney Transplant candidates

456 GFR assessment in Combined Heart-Kidney Transplant candidates

(965) - Incidence and Outcomes of BKV in Simultaneous Heart-Kidney Transplant Recipients: A Multi-Center Review

(965) - Incidence and Outcomes of BKV in Simultaneous Heart-Kidney Transplant Recipients: A Multi-Center Review

(24) - Bridge to Simultaneous Heart-Kidney Transplantation via Extracorporeal Life Support: National Outcomes in the New Heart Allocation Policy Era

(24) - Bridge to Simultaneous Heart-Kidney Transplantation via Extracorporeal Life Support: National Outcomes in the New Heart Allocation Policy Era

(745) - Gene Expression Profiling and Donor-Derived Cell-Free DNA in Clinically Stable Heart-Kidney Transplant Recipients

(745) - Gene Expression Profiling and Donor-Derived Cell-Free DNA in Clinically Stable Heart-Kidney Transplant Recipients