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Outcomes in Patients With LVADs Undergoing Simultaneous Heart-Kidney Transplantation

      Highlights

      • Simultaneous heart-kidney transplants are becoming more common in patients with left ventricular assist devices (LVADs) and chronic kidney disease.
      • This study shows that both short- and long-term survival is worse in patients with simultaneous heart-kidney transplants than in patients with orthotopic heart transplants when patients have chronic kidney disease and LVADs.
      • Further investigation is needed to determine whether kidney-after-heart transplant would be a better strategy for patients with LVADs needing both cardiac and renal transplants.

      ABSTRACT

      Background

      Multiple studies have shown better outcomes for simultaneous heart-kidney transplant (sHKT) than for isolated orthotopic heart transplant (iOHT) in recipients with chronic kidney disease (CKD). However, outcomes in patients supported by durable left ventricular assist devices (LVADs) have not been well studied.

      Methods

      Patients with durable LVADs and stage 3 or higher CKD (eGFR < 60 mL/min/1.73 m2) undergoing iOHT or sHKT between 2008 and 2020 were identified from the United Network for Organ Sharing registry. A Kaplan-Meier survival analysis with associated log-rank test was conducted to compare post-transplant survival rates. Multivariable modeling was used to identify risk-adjusted predictors of 1 year post-transplant mortality.

      Results

      We identified 4375 patients; 366 underwent sHKT, and 4009 underwent iOHT. The frequency of sHKT increased during the study period. The 1-year post-transplant survival rate was worse in patients after sHKT than in patients after iOHT (80.3% vs 88.3%; P < 0.001) and persisted up to 5 years post-transplant (P = 0.001). sHKT recipients were more likely to require dialysis after transplantation and had longer hospital lengths of stay (P < 0.001). Multivariable analysis showed that sHKT remained an independent risk factor for mortality at 1 year (OR 1.58; P = 0.002).

      Conclusions

      sHKT is becoming more common in patients with durable LVADs. Compared with iOHT, patients with sHKTs have worse short- and long-term survival rates and are more likely to require post-transplant dialysis.

      Graphical abstract

      Key Words

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