JACC. Heart failure · 2026
10-Year Survival and Renal Outcomes After Simultaneous Heart-Kidney Transplantation in Heart Retransplant Recipients.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Isath Ameesh, Tadokoro Naoki, Schoenrath Felix, Vukićević Milica, Faria Vanessa, Dey Tanujit, Godding Mark, Givertz Michael M, Itoh Akinobu, Mehra Mandeep R
Аннотация
BACKGROUND: Renal dysfunction is common in heart retransplant (re-HT) candidates and adversely influences outcomes. Although simultaneous heart-kidney transplantation (SHKT) is established in primary transplantation for severe renal dysfunction, its long-term benefit in the re-HT setting remains incompletely defined.
OBJECTIVES: This study sought to evaluate 10-year survival and renal trajectories after SHKT compared with isolated re-HT.
METHODS: Adult patients undergoing re-HT (2000-2024) were identified from the UNOS (United Network for Organ Sharing) registry and categorized as isolated re-HT or simultaneous heart-kidney retransplantation (re-SHKT). The primary outcome was 10-year survival. Secondary outcomes evaluated renal outcomes, rejection, and cardiac allograft vasculopathy. Multivariable Cox regression and Fine-Gray competing risk models were used to adjust for recipient, donor, and era-related covariates.
RESULTS: Among 1,378 re-HT recipients, 304 (22%) underwent re-SHKT. Despite worse baseline renal function, re-SHKT was associated with improved 10-year survival (71.2% vs 59.1%, respectively; adjusted HR: 0.51; 95% CI: 0.38-0.70; P < 0.001). Survival benefit was observed in recipients with a pretransplant estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2 but not in those recipients with eGFR ≥45 mL/min/1.73 m2. Isolated re-HT recipients with baseline renal impairment (eGFR <45 mL/min/1.73 m2) demonstrated a graded increase in subsequent kidney transplantation and death before rescue transplantation. Re-SHKT was associated with an 84% reduction in subsequent kidney transplantation and fewer treated rejection episodes.
CONCLUSIONS: In re-HT recipients, SHKT was associated with sustained 10-year survival benefit and favorable renal trajectories, particularly in patients with moderate to severe renal dysfunction. These findings support dual-organ allocation in selected re-HT candidates with moderate to severe renal dysfunction.
OBJECTIVES: This study sought to evaluate 10-year survival and renal trajectories after SHKT compared with isolated re-HT.
METHODS: Adult patients undergoing re-HT (2000-2024) were identified from the UNOS (United Network for Organ Sharing) registry and categorized as isolated re-HT or simultaneous heart-kidney retransplantation (re-SHKT). The primary outcome was 10-year survival. Secondary outcomes evaluated renal outcomes, rejection, and cardiac allograft vasculopathy. Multivariable Cox regression and Fine-Gray competing risk models were used to adjust for recipient, donor, and era-related covariates.
RESULTS: Among 1,378 re-HT recipients, 304 (22%) underwent re-SHKT. Despite worse baseline renal function, re-SHKT was associated with improved 10-year survival (71.2% vs 59.1%, respectively; adjusted HR: 0.51; 95% CI: 0.38-0.70; P < 0.001). Survival benefit was observed in recipients with a pretransplant estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2 but not in those recipients with eGFR ≥45 mL/min/1.73 m2. Isolated re-HT recipients with baseline renal impairment (eGFR <45 mL/min/1.73 m2) demonstrated a graded increase in subsequent kidney transplantation and death before rescue transplantation. Re-SHKT was associated with an 84% reduction in subsequent kidney transplantation and fewer treated rejection episodes.
CONCLUSIONS: In re-HT recipients, SHKT was associated with sustained 10-year survival benefit and favorable renal trajectories, particularly in patients with moderate to severe renal dysfunction. These findings support dual-organ allocation in selected re-HT candidates with moderate to severe renal dysfunction.