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

Background: Simultaneous heart and kidney transplantation has been considered for patients who had advanced CKD and ESRD who have an indication for heart transplantation. In this study, we analyzed whether there is an increase in patient survival and heart transplant graft survival. Methods: We analyzed data from the OPTN patients who received heart transplant with CKD/ESRD 1/2020-12/2023. Our inclusion criteria were adults aged >18 years old receiving a solid organ heart transplant with evidence of CKD, defined as eGFR less than 60 or on dialysis for heart transplant alone, and who were ABO compatible. Our outcomes were heart graft loss, defined as receiving another heart transplant or death, and death was defined patient expiring as per UNOS. Multivariable Cox regression was used to evaluate defined patient survival and graft survival while adjusting for recipient, donor, and graft characteristics. Results: A total of 22,111 transplants were performed, 86.6% of which were HTx and 13.4% of which were SHKTx. The prevalence of graft loss was 40.7% and death was 41.6% overall. We see better patient and graft survival with simultaneous heart-kidney compared to heart alone in all stages of CKD and including the different stages of CKD in graft failure and death as shown in Table 1 and Figure 2 and 3. Our study have the limitation of selection bias as it is unclear why there are patients with CKD/ESRD who did not receive simultaneous heart and kidney transplantation. The other bias the eGFR were calculated by using serum creatinine as a marker and unclear it will be the ideal marker given the patient with end-stage heart failure usually have cachexia with low muscle mass. Conclusion: SHK transplantation has an increased benefit in patient and heart transplant survival compared to patients who received heart transplantation alone. Prospective studies should be performed to determine the ideal eGFR cutoff for patient listing.