Background
Extended criteria donors (ECD) hearts have demonstrated acceptable outcomes in select
populations. However, their use in patients undergoing simultaneous heart-kidney transplantation
(SHKT) has not been explored. This study is assessed the effect of ECD hearts in patients
undergoing SHKT vs isolated heart transplants (IHT).
Methods
The United Network for Organ Sharing (UNOS) database was queried for all adult patients
undergoing IHT and SHKT. Patients were stratified by receipt of ECD heart, defined
as donor hearts failing to meet established acceptable use criteria. Interaction effects
between ECDs and simultaneous kidney transplants were generated. Postoperative outcomes,
risk factors, and patient/graft survival were compared across cohorts using Fine-Gray,
Kaplan Meier, and Cox Proportional Hazards analyses.
Results
Among 26,207 patients included, 1,766 (7%) underwent SHKT. ECD hearts were used in
25% of both IHT and SHKT cohorts. Five-year survival among SHKT/ECD patients (67.3%)
was reduced (p < 0.01) compared to SHKT/SDC (80.3%), IHT/ECD (78.1%) and IHT/SCD (80.0%) groups.
Among SHKT patients, use of ECD hearts was associated with increased risk (SHR: 1.48;
p < 0.01) of renal graft failure compared to SCD hearts. Among SHKT patients, receipt
of an ECD heart, and individual ECD criteria (coronary disease and size mismatch >20%),
predicted mortality. The interaction effect of receiving both ECD and SHKT predicted
mortality and graft failure (HR 1.43; p < 0.01).
Conclusions
Patients undergoing SHKT with an ECD heart face greater risks of mortality and graft
failure in comparison to those undergoing IHT with ECD hearts. Careful selection of
donor organs should be applied to this high-risk cohort.
KEYWORDS
Abbreviations:
UNOS (United Network for Organ Sharing), ECD (Extended Criteria Donor), SCD (Standard Criteria Donor), SHKT (Simultaneous Kidney-Heart Transplantation), IHT (Isolated Heart Transplantation)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Heart and Lung TransplantationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Higher rates of dialysis and subsequent mortality in the new allocation era for heart transplants.Ann Thorac Surg. 2022; 155: 502-509
- Combined heart-kidney transplant improves post-transplant survival compared with isolated heart transplant in recipients with reduced glomerular filtration rate: Analysis of 593 combined heart-kidney transplants from the United Network Organ Sharing Database.J Thorac Cardiovasc Surg. 2014; 147: 456-461.e1
- Heart and combined heart-kidney transplantation in patients with concomitant renal insufficiency and end-stage heart failure.Am J Transplant. 2014; 14: 384-396
- Striking a balance in simultaneous heart kidney transplant: optimizing outcomes for all wait-listed patients.J Am Soc Nephrol. 2020; 31: 1661-1664
- Consensus conference on heart-kidney transplantation.Am J Transplant. 2021; 21: 2459-2467
- OPTN/SRTR 2018 annual data report: heart.Am J Transplant. 2020; 20: 340-426
- Impact of center donor acceptance patterns on utilization of extended-criteria donors and outcomes.J Card Surg. 2021; 36: 4015-4023
- Increasing heart transplant volume by expansion of donor heart selection criteria: a single-center analysis.Transplant Proc. 2020; 52: 949-953
- Ten-year experience with extended criteria cardiac transplantation.Circ Heart Fail. 2013; 6: 1230-1238
- Expanded criteria donors for kidney transplantation.Am J Transplant. 2003; 3: 114-125
- Cardiac size and sex-matching in heart transplantation : size matters in matters of sex and the heart.JACC Heart Fail. 2014; 2: 73-83
- Donor heart and lung procurement: a consensus statement.J Heart Lung Transplant. 2020; 39: 501-517
- Increased Use of Multiorgan Transplantation in Heart Transplantation: Only Time Will Tell.Ann Thorac Surg. 2020; 110: 1308-1315
- Modern outcomes of heart-lung transplantation: assessing the impact of the updated united states allocation system.Eur J Cardiothorac Surg. 2022; 63ezac559
- Heart transplantation in the new era of extended donor criteria.J Card Surg. 2021; 36: 4828-4829
- Outcome after heart transplantation from older donor age: expanding the donor pool.Eur J Cardiothorac Surg. 2015; 47: 672-678
- Marginal versus standard donors in heart transplantation: proper selection means heart transplant benefit.J Clin Med. 2022; 112665
- Outcomes with an alternate list strategy for heart transplantation.J Heart Lung Transplant. 2005; 24: 1781-1786
- Functional and morphologic adaptation of undersized donor hearts after heart transplantation.J Am Coll Cardiol. 1995; 26: 737-742
- Predicted heart mass is the optimal metric for size match in heart transplantation.J Heart Lung Transplant. 2019; 38: 156-165
- Influence of donor-transmitted coronary artery disease on long-term outcomes after heart transplantation - a retrospective study.Transpl Int. 2021; 34: 281-289
- Influence of donor transmitted and rapidly progressive coronary vascular disease on long-term outcomes after heart transplantation: a contemporary intravascular ultrasound analysis.J Card Fail. 2021; 27: 464-472
- Coronary atherosclerosis of the donor heart–impact on early graft failure.Eur J Cardiothorac Surg. 2007; 32: 634-638
- Influence of pre-existing donor atherosclerosis on the development of cardiac allograft vasculopathy and outcomes in heart transplant recipients.J Am Coll Cardiol. 2006; 47: 2470-2476
- Combined heart and kidney transplantation-Is there a protective effect against cardiac allograft vasculopathy using intravascular ultrasound?.J Heart Lung Transplant. 2019; 38: 956-962
- Coronary artery disease in renal transplant recipients.Cleve Clin J Med. 1994; 61: 370-385
- Coronary revascularization versus optimal medical therapy in renal transplant candidates with coronary artery disease: a systematic review and meta-analysis.J Am Heart Assoc. 2022; 11e023548
- Incidence and predictors of myocardial infarction after kidney transplantation.J Am Soc Nephrol. 2005; 16: 496-506
- Report from the american society of transplantation conference on donor heart selection in adult cardiac transplantation in the United States.Am J Transplant. 2017; 17: 2559-2566
- Extended donor criteria in heart transplantation: a retrospective study from a single Chinese institution.J Thorac Dis. 2018; 10: 2153-2165
- Great variability in donor heart acceptance practices across the United States.Am J Transplant. 2020; 20: 1582-1596
Article info
Publication history
Published online: February 19, 2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 International Society for Heart and Lung Transplantation. All rights reserved.
