Combined Heart-Kidney Transplantation: Indications, Outcomes, and Controversies

Abstract

Renal dysfunction, a prevalent comorbidity in advanced heart failure, is associated with significant morbidity and mortality after heart transplantation. In the recent era, the field of combined heart-kidney transplantation has experienced great success in the treatment of both renal and cardiac dysfunction in end-stage disease states, and the number of transplants has increased dramatically. In this review, we discuss appropriate indications and selection criteria, overall and organ-specific outcomes, and future perspectives in the field of combined heart-kidney transplantation.

Double heart-kidney transplantation: a brief review of the literature

“…In addition, when comparing overall survival in separate populations, patients with Double Heart-Kidney Transplantation have increased in-hospital mortality, resulting in reduced 1-year survival rates compared to patients undergoing separate kidney and heart transplants, given the greater complexity of the procedure 8 . On the other hand, in well-selected cases, 5-and 10-year heart graft survival is significantly better in patients undergoing Double Heart-Kidney Transplant compared to patients undergoing heart transplant only 8 .…”

“…In this context it is difficult to know which patients who would really benefit from this approach must undergo careful selection. To this end, studies are being conducted in order to establish criteria to find the best candidate patients for the approach 7,8 .…”

Evolutions in Combined Heart-Kidney Transplant

“…Of note, in addition to survival benefit, recipients of SHKT have a decreased risk of rejection and coronary allograft vasculopathy [ 7 ••, 8 , 13 – 15 ]. There are multiple possible factors that may explain this observation, including the fact that kidney tissue has significantly higher HLA antigen levels than heart tissue [ 16 ]; additionally, in animal models, donor kidneys may possess cells that migrate to the host thymus and induce tolerance to donor antigens [ 14 , 17 , 18 ].…”

“…Rates of kidney allograft survival at 1 year post-SHKT are also significantly lower when compared to kidney transplant alone, largely driven by worse 1-year patient survival, which is approximately 96% after kidney transplant alone, but ranges from 62 to 84% after SHKT [ 9 , 17 , 21 ]. The need for post-operative extra-corporeal membrane oxygenation, hemodynamic instability requiring intensive care unit management, and dialysis are predictors of post-operative mortality after SHKT [ 21 , 22 ].…”

Simultaneous Heart and Kidney Transplantation: A Systematic Review and Proportional Meta-Analysis of Its Characteristics and Long-Term Variables

“…Patients with end-stage heart disease who undergo heart transplantation alone (HTx) frequently have simultaneous kidney insufficiency, leading to an outcome of reduced survival [1], as kidney failure is a predictor of morbidity and mortality in patients after HTx [2]. Since simultaneous heart and kidney transplantation (sHKTx) was first described in 1978 by Norman et al [3], it has become a recognized therapy for simultaneous end-stage cardiac and renal failure, with increased numbers since 2010 and representing more than 5% of the total number of HTx performed in the United States currently [4].…”