Combined heart-kidney transplants show better patient, graft survival than single-organ transplant

BOSTON — Although only younger donor age was found to be significantly associated with improved survival, research presented here showed patients who received combined heart-kidney transplants had better overall survival and rejection-free graft outcomes at 1 year, 5 years and 10 years post-transplant compared with patients who had heart transplants alone.

“Analysis of combined heart-kidney transplants (HKTx) reveals equivalent or improved patient survival and reduced allograft rejection rates as compared to single-organ transplants,” Victoria M. Lim, MD, and colleagues from the Mayo Clinic in Phoenix wrote in their abstract. “We seek to provide an updated comprehensive analysis of risk factors and outcomes in the HKTx cohort, which may help guide future selection processes and therapeutic interventions.”

The Mayo researchers looked at HKTx patients from 2010 until 2017 with information in the United Network for Organ Sharing database. Univariate Cox proportional hazard models were used to determine risk factors for patient overall survival.

“The results showed that 1-, 5- and 10-year overall survival estimates for the 1,148-patient cohort were 86.9%, 76.7%, and 59.7%, respectively,” Lim and colleagues wrote. “1-, 5- and 10-year rejection-free survival estimates for the entire cohort were 83.9%, 71.8%, and 54%, respectively. Of the 1,148 patients, 69% experienced no rejection in either organ, 1.7% experienced only heart rejection, 3.3% experienced only kidney rejection and 26% had dual-organ rejection.”

The authors noted that donor age was significantly associated with survival.

“No other variables analyzed for both donor and recipient were found to be significantly associated with survival, including gender, blood type, dialysis at time of transplant and kidney cold ischemic time or heart ischemic time,” the researchers wrote.

“Overall survival was significantly higher in patients with donors age [younger than] 41 [years], with median survival estimates of 149.3 months compared to 116.3 months (log-rank P=.001). Rejection-free survival was significantly higher in patients with donors age [younger than] 41 [years] with median survival estimates of 141.4 months compared to 99.3 months (log-rank P=<.001).”

Negative variables in the study included previous number of transplants, left ventricular ejection fraction and intra-aortic balloon pump at transplant, according to the abstract.

Reference:

Lim VM, et al. Abstract 295. Presented at: American Transplant Congress; June 1-5, 2019; Boston.

Disclosures: Healio/Nephrology was unable to determine relevant financial disclosures prior to publication.