Factors Impacting Early Adverse Outcomes in Simultaneous Heart-Kidney Transplantation

Bernard John DuBray; Saed Shawar; Sandip Zalawadiya; Kelly Schlendorf; Bonnie Ann Sarrell; Beatrice P Concepcion; Scott A Rega; Irene D Feurer; David Shaffer; Rachel C Forbes

doi:10.1016/j.transproceed.2024.11.037

Factors Impacting Early Adverse Outcomes in Simultaneous Heart-Kidney Transplantation

Transplant Proc. 2025 Jan 21:S0041-1345(24)00678-X. doi: 10.1016/j.transproceed.2024.11.037. Online ahead of print.

Authors

Affiliations

¹ Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: [email protected].
² Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee.
³ Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
⁴ Section of Nephrology, University of Chicago, Chicago, Illinois.
⁵ Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, Tennessee.
⁶ Departments of Surgery and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
⁷ Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee.

PMID: 39837670
DOI: 10.1016/j.transproceed.2024.11.037

Abstract

Background: Over the last decade, the number of simultaneous heart-kidney transplants (SHKTs) has increased dramatically. There are few reports of renal allograft outcomes in these high acuity patients. The goal of the present study was to identify variables that were related to early adverse outcomes (EAOs), including delayed graft function (DGF), primary non-function (PNF), and renal allograft futility (RAF) after SHKTs.

Methods: We performed a single center retrospective review of all adults undergoing SHKTs from October 2011 to August 2021. Multivariable logistic regression models with backward elimination were used to test the relationships between recipient (pre-transplant dialysis, intra-aortic balloon pump, serum lactate, norepinephrine use, and re-do sternotomy) and operative (cold ischemia time [CIT]) variables and the likelihood of DGF, PNF, and RAF.

Results: Sixty-eight patients underwent SHKT during the study period. Overall, patient survival was 87%, 83%, and 80% at 6 months, 1 year, and 3 years, respectively. Twenty-four patients (35%) experienced DGF, whereas 4 patients (6%) had PNF, and 12 patients (18%) had RAF (Table 1). Pre-transplant dialysis, serum lactate, and CIT were significantly associated with an increased likelihood of DGF. Norepinephrine (NE) and CIT were associated with increased likelihood of RAF (Table 2).

Conclusions: Pre-transplant dialysis is related to an increased likelihood of EAO following SHKT, with CIT and NE contributing to increased likelihood of RAF. Given that SHKT recipients are at risk of remaining on dialysis following SHKT, strategies that allow for expedited kidney transplantation after heart transplantation may mitigate the hemodynamic and ischemic constraints of SHKT that contribute to early adverse outcomes.