Induction regimen and survival in simultaneous heart-kidney transplant recipients

Ariyamuthu, Venkatesh Kumar; Amin, Alpesh; Drazner, Mark H.; Araj, Faris G.; Mammen, Pradeep P.A.; Ayvaci, Mehmet; Mete, Mutlu; Ozay, Fatih; Ghanta, Mythili; Mohan, Sumit; Mohan, Prince; Tanrıöver, Bekir

doi:10.1016/j.healun.2017.11.012

Cited by 15 publications

(10 citation statements)

References 43 publications

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“…If induction is to be used, the choice of agent for induction therapy needs to be personalized based on recipient's risk factors for infection, presence or absence of delayed graft function and recipient's immunologic profile 19 . For sensitized recipients and patients with delayed graft function, anti‐thymocyte globulin (ATG) induction can be considered 20 . For recipients with lower immunologic risk or at risk for infection, basiliximab induction can be considered.…”

Section: Results Of the Multidisciplinary Breakout Session Groupsmentioning

confidence: 99%

“…19 For sensitized recipients and patients with delayed graft function, anti-thymocyte globulin (ATG) induction can be considered. 20 For recipients with lower immunologic risk or at risk for infection, basiliximab induction can be considered. Based on KT experience, the consensus from the nephrologists in the Heart/Kidney Workgroup was that calcineurin inhibitor (CNI) delay is not necessary for kidney protection.…”

Section: Managementmentioning

confidence: 99%

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Consensus conference on heart-kidney transplantation

Kobashigawa

Dadhania

Farr

et al. 2021

American Journal of Transplantation

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Simultaneous heart‐kidney transplant (sHK) has enabled the successful transplantation of patients with end‐stage heart disease and concomitant kidney disease, with non‐inferior outcomes to heart transplant (HT) alone. The decision for sHK is challenged by difficulties in differentiating those patients with a significant component of reversible kidney injury due to cardiorenal syndrome who may recover kidney function after HT, from those with intrinsic advanced kidney disease who would benefit most from sHK. A consensus conference on sHK took place on June 1, 2019 in Boston, Massachusetts. The conference represented a collaborative effort by experts in cardiothoracic and kidney transplantation from centers across the United States to explore the development of guidelines for the interdisciplinary criteria for kidney transplantation in the sHK candidate, to evaluate the current allocation of kidneys to follow the heart for sHK, and to recommend standardized care for the management of sHK recipients. The conference served as a forum to unify criteria between the different specialties and to forge a pathway for patients who may need dual organ transplantation. Due to the continuing shortage of available donor organs, ethical problems related to multi‐organ transplantation were also debated. The findings and consensus statements are presented.

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Section: Results Of the Multidisciplinary Breakout Session Groupsmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Consensus conference on heart-kidney transplantation

Kobashigawa

Dadhania

Farr

et al. 2021

American Journal of Transplantation

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“…Recipients of rATG induction experienced similar patient survival (hazard ratio [HR] 0.81; 95% CI, 0.44–1.46; p = 0.48) as compared with no induction. However, when only sensitized patients were analyzed, survival was improved with rATG versus no induction (HR 0.19; 95% CI, 0.05–0.71; p < 0.001) 40 . The rates for infection requiring hospitalization for patients receiving rATG, IL2RA, and no induction were 45%, 50%, and 43% ( p = 0.28), respectively.…”

Section: Simultaneous Heart‐kidney Transplantationmentioning

confidence: 98%

Immunosuppression considerations in simultaneous organ transplant

et al. 2021

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Solid organ transplantation is a life‐saving procedure for patients in the end stage of heart, lung, kidney, and liver failure. For patients with more than one failing organ, simultaneous organ transplantation has emerged as a viable treatment option. Immunosuppression strategies and outcomes for simultaneous organ transplant recipients have been reported, but often involve limited populations. Transplanting dual organs poses challenges in terms of balancing immunosuppression with immunologic risk and allograft damage from surgical complications. Furthermore, transplanting certain organs can impose considerations on the management of immunosuppression. For example, liver allografts may confer immunologic privilege and lower rates of rejection of other allografts. This review article evaluates immunosuppression strategies for simultaneous kidney‐pancreas, liver‐kidney, heart‐kidney, heart‐liver, heart‐lung, lung‐liver, and lung‐kidney transplants. To date, no comprehensive review exists to address immunosuppressive strategies in simultaneous organ transplant populations. Our review summarizes the available literature and provides evidence‐based recommendations regarding immunosuppression strategies in simultaneous organ transplant recipients.

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“…In moderately sensitized patients (positive DSA and negative flow crossmatch), induction with ATG resulted in reduced occurrence of de novo DSA (dnDSA) and AMR compared to basiliximab [38]. In simultaneous heart and kidney transplants, sensitized patients (with PRA > 10%) treated with rATG induction had lower mortality [39]. Another randomized trial found a significantly reduced incidence as well as severity of acute rejection in high immunological risk patients, defined by Kidney Disease Improving Global Outcomes (KDIGO) as high number of MHC mismatches, younger recipient, older donor, PRA > 0%, presence of DSA, blood group incompatibility, DGF, and cold ischemic time > 24 h, treated with rATG versus basiliximab with acute rejection rates at 1 year (15% vs. 27%, p = 0.016) and 5 years (14% vs. 26%, p = 0.035) [37,40,41].…”

Section: Thymoglobulinmentioning

confidence: 99%

Optimal Immunosuppression Strategy in the Sensitized Kidney Transplant Recipient

Olaso

Manook

Moris

et al. 2021

JCM

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Patients with previous sensitization events against anti-human leukocyte antigens (HLA) often have circulating anti-HLA antibodies. Following organ transplantation, sensitized patients have higher rates of antibody-mediated rejection (AMR) compared to those who are non-sensitized. More stringent donor matching is required for these patients, which results in a reduced donor pool and increased time on the waitlist. Current approaches for sensitized patients focus on reducing preformed antibodies that preclude transplantation; however, this type of desensitization does not modulate the primed immune response in sensitized patients. Thus, an optimized maintenance immunosuppressive regimen is necessary for highly sensitized patients, which may be distinct from non-sensitized patients. In this review, we will discuss the currently available therapeutic options for induction, maintenance, and adjuvant immunosuppression for sensitized patients.

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Induction regimen and survival in simultaneous heart-kidney transplant recipients

Abstract: r-ATG may provide a survival benefit in SHKT, especially in sensitized patients maintained on TAC/MPA/PRED at hospital discharge.

Cited by 15 publications

References 43 publications

Consensus conference on heart-kidney transplantation

Consensus conference on heart-kidney transplantation

Immunosuppression considerations in simultaneous organ transplant

Optimal Immunosuppression Strategy in the Sensitized Kidney Transplant Recipient

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