Background
Combined heart and kidney transplantation (
HKT
x) is performed in patients with severe heart failure and advanced renal insufficiency. We analyzed the long‐term survival after
HKT
x, the influence of age and dialysis status, the rates of cardiac rejection, and the influence of sensitization.
Methods and Results
From June 1992 to December 2016, we performed 100
HKT
x procedures. We compared older (≥60 years, n=53) with younger (<60 years, n=47) recipients, and recipients on preoperative dialysis (n=49) and not on dialysis (n=51). We analyzed actuarial freedom from any cardiac rejection, acute cellular rejection, and antibody‐mediated rejection, and survival rates by sensitized status with panel‐reactive antibody levels <10%, 10% to 50%, and >50%, and compared these survival rates with those from the
United Network for Organ Sharing
database. There was no difference in 15‐year survival between the 2 age groups (35±12.4% and 49±17.3%, ≥60 versus <60 years;
P
=0.45). There was no difference in 15‐year survival between the dialysis and nondialysis groups (44±13.4% and 37±15.2%,
P
=0.95). Actuarial freedom from any cardiac rejection (
acute cellular rejection
>0 or
antibody‐mediated rejection
>0) was 92±2.8% and 84±3.8%,
acute cellular rejection
(≥2R/3A) 98±1.5% and 94±2.5%, and
antibody‐mediated rejection
(≥1) 96±2.1% and 93±2.6% at 30 days and 1 year after
HKT
x. There was no difference in the 5‐year survival among recipients by sensitization status with
panel‐reactive antibody
levels <10%, 10% to 50%, and >50% (82±5.9%, 83±10.8%, and 92±8.0%;
P
=0.55). There was no difference in 15‐year survival after
HKT
x between the
United Network for Organ Sharing
database and our center (38±3.2% and 40±10.1%, respectively;
P
=0.45).
Conclusions
HKT
x is safe to perform in patients 60 years and older or younger than 60 years and with or without dialysis dependence, with excellent outcomes. The degree of
panel‐reactive antibody
sensitization did not appear to affect survival after
HKT
x.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.