Short And Long Term Outcomes Of Combined Heart And Kidney Transplantation: A Single-Center Experience

Background: In patients with end-stage heart failure requiring heart transplantation, end-stage disease of a second organ may require consideration of simultaneous dual-organ transplantation. Combined heart kidney transplantation (CHKT) has become accepted as a viable therapeutic plan in this challenging clinical scenario and its prevalence has increased dramatically (147%) from 2000–2010, compared to only modest increase (3.6%) in isolated heart transplantation (OHT). However, little data has been published on the outcomes of CHKT. Methods: Retrospective analysis was performed on all patients between 2005–2015 treated with CHKT or OHT in a large volume academic center. We reviewed demographic as well as pre, peri and post-operative outcomes. Results: A total of 20 patients treated with CHKT (75.0% male, mean age 53.25 ± 9.5) and 250 patients treated with OHT (69.9% male, mean age 52.36 ± 11.8) were included in this study. All 20 patients underwent successful CHKT, with demographic and pre-operative characteristics similar to previously published literature. Kaplan-Meier analysis demonstrated excellent 1 and 5-year survival in OHT compared with CHKT (90.2% vs. 85% at 1 year, P = .455; 67.1% vs. 55.0% at 5 years, P = .272) without statistically significant difference. Interestingly, rates of rejection were significantly decreased amongst those received CHKT (58.5% vs. 30.0%, P = .01). Fungal infections were almost five times more likely within CHKT (15.0% vs. 3.3%, P = .01), while cumulative infection rates were decreased in CHKT, approaching significance between groups (30.0% vs. 51.6%, P = .06). Notably, new-onset malignancy was less common among CHKT, without reaching statistical significance (10.0% vs. 27.6%, P = .085) Conclusions: This retrospective review is a large single-center series to evaluate combined heart-kidney transplantation outcomes. While demonstrating equivalent survival at both 1 year and 5 years, future studies are needed to evaluate whether CHKT may confer improved morbidity in relation to infection, rejection and new onset malignancy. Concomitant transplantation may provide immune-mediated projection from such highly morbid complications.