Dual-organ transplantation in older recipients: outcomes after heart–kidney transplant versus isolated heart transplant in patients aged ≥65 years†

Reich, Heidi; Dimbil, S.; Levine, R.; Megna, D.; Mersola, S.; Patel, Jignesh; Kittleson, M.; Czer, L.; Kobashigawa, Jon A.; Esmailian, F.

doi:10.1093/icvts/ivy202

Cited by 14 publications

(21 citation statements)

References 15 publications

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“…One question that may arise in the light of our results is whether combined kidney–HT (KHT) is an option for patients with compromised kidney function (or even renal failure) and whether this will result in less ESRD in the long term. Several studies (both single‐centre and national) have demonstrated a good survival after KHT . In some studies using the United Network for Organ Sharing database, there was even a survival benefit for patients undergoing combined KHT in comparison with HT alone .…”

Section: Discussionmentioning

confidence: 99%

Incidence of end‐stage renal disease after heart transplantation and effect of its treatment on survival

et al. 2020

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Aims Many heart transplant recipients will develop end-stage renal disease in the post-operative course. The aim of this study was to identify the long-term incidence of end-stage renal disease, determine its risk factors, and investigate what subsequent therapy was associated with the best survival. Methods and results A retrospective, single-centre study was performed in all adult heart transplant patients from 1984 to 2016. Risk factors for end-stage renal disease were analysed by means of multivariable regression analysis and survival by means of Kaplan-Meier. Of 685 heart transplant recipients, 71 were excluded: 64 were under 18 years of age and seven were re-transplantations. During a median follow-up of 8.6 years, 121 (19.7%) patients developed end-stage renal disease: 22 received conservative therapy, 80 were treated with dialysis (46 haemodialysis and 34 peritoneal dialysis), and 19 received a kidney transplant. Development of end-stage renal disease (examined as a time-dependent variable) inferred a hazard ratio of 6.45 (95% confidence interval 4.87-8.54, P < 0.001) for mortality. Tacrolimus-based therapy decreased, and acute kidney injury requiring renal replacement therapy increased the risk for end-stage renal disease development (hazard ratio 0.40, 95% confidence interval 0.26-0.62, P < 0.001, and hazard ratio 4.18, 95% confidence interval 2.30-7.59, P < 0.001, respectively). Kidney transplantation was associated with the best median survival compared with dialysis or conservative therapy: 6.4 vs. 2.2 vs. 0.3 years (P < 0.0001), respectively, after end-stage renal disease development. Conclusions End-stage renal disease is a frequent complication after heart transplant and is associated with poor survival. Kidney transplantation resulted in the longest survival of patients with end-stage renal disease.

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Section: Discussionmentioning

confidence: 99%

Incidence of end‐stage renal disease after heart transplantation and effect of its treatment on survival

et al. 2020

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“…Multiple studies have shown survival at 1 and 5 years after CHKTx to be similar to survival after isolated heart transplantation. 5,11,12 Outcomes studies based on UNOS data also show a significantly decreased risk of graft rejection of both organs at 1 year in CHKTx, compared with each organ being transplanted alone. 13 Though the mechanism for this immune tolerance is unknown, current hypotheses include induction of tolerance by a greater number of passenger leukocytes, enhanced induction of regulatory T-cells, and immune diversion, in which one organ protects the other from attack.…”

Section: Combined Heart-kidney Transplants (Chktx)mentioning

confidence: 95%

“…CHKTx begins with cardiac transplantation, and the kidney is transplanted either sequentially during the same operating room encounter or as a staged procedure allowing a short recovery period that is typically less than 24 hours in the intensive care unit (ICU). 8,11 The timing of kidney transplantation depends on hemodynamic stability of the patient, the availability of the kidney, and the experience of the transplantation center. 8 A staged procedure is commonly used to protect the kidney allograft from hemodynamic instability after heart transplantation, the inflammatory sequelae of CPB, and the effects of vasoconstrictor medications.…”

Section: Intraoperative Managementmentioning

confidence: 99%

“…Dobutamine is the first-line inotrope in these patients because it increases cardiac output and provides chronotropic support to the newly transplanted heart while improving peripheral perfusion. 11 Patients whose chest tube output is within acceptable limits and who are hemodynamically stable on low doses of vasoconstrictors should promptly return to the operating room for kidney transplantation.…”

Section: Intraoperative Managementmentioning

confidence: 99%

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Combined Thoracic and Abdominal Organ Transplantation: Special Considerations

Yager

Khorsand

Chokshi

et al. 2019

Semin Cardiothorac Vasc Anesth

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Combined thoracic-abdominal organ transplants are infrequently performed procedures indicated for patients with failure of two or more transplantable organs. In this review, we discuss recipient selection, surgical considerations, anesthetic management, and outcomes associated with common combinations of thoracic-abdominal transplant operations. General principles regarding the postoperative care of these patients are also discussed. These procedures present a unique challenge requiring specialized knowledge, technical expertise, and leadership from the anesthesiology team throughout the perioperative period.

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“…Likewise, cardiovascular risk factor in kidney transplantation (KTx) is well correlated with higher post‐transplantation mortality (Seoane‐Pillado et al, 2017). Multiple studies have shown combined heart and kidney transplantation (HKTx) to be a safe option in patients with concomitant heart and kidney failure (Reich et al, 2019; Wong et al, 2017). HKTx reduces rate of cardiac allograft vasculopathy and dysfunction than HTx alone (Karamlou et al, 2014; Sato et al, 2019).…”

Section: Diagnosis Prognosis and Treatment Of Cardiorenal Syndromementioning

confidence: 99%

Cardiorenal syndrome: Multi‐organ dysfunction involving the heart, kidney and vasculature

Savira

Magaye

Liew

et al. 2020

British J Pharmacology

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Cardiorenal syndrome (CRS) is a multi-organ disease, encompassing heart, kidney and vascular system dysfunction. CRS is a worldwide problem, with high morbidity, mortality, and inflicts a significant burden on the health care system. The pathophysiology is complex, involving interactions between neurohormones, inflammatory processes, oxidative stress and metabolic derangements. Therapies remain inadequate, mainly comprising symptomatic care with minimal prospect of full recovery. Challenges include limiting the contradictory effects of multi-organ targeted drug prescriptions and continuous monitoring of volume overload. Novel strategies such as multi-organ transplantation and innovative dialysis modalities have been considered but lack evidence in the CRS context. The adjunct use of pharmaceuticals targeting alternative pathways showing positive results in preclinical models also warrants further validation in the clinic. In recent years, studies have identified the involvement of gut dysbiosis, uraemic toxin accumulation, sphingolipid imbalance and other unconventional contributors, which has encouraged a shift in the paradigm of CRS therapy.

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Dual-organ transplantation in older recipients: outcomes after heart–kidney transplant versus isolated heart transplant in patients aged ≥65 years†

Abstract: For patients ≥65-year old, heart-kidney transplant can achieve outcomes on par with heart transplant alone.

Cited by 14 publications

References 15 publications

Incidence of end‐stage renal disease after heart transplantation and effect of its treatment on survival

Incidence of end‐stage renal disease after heart transplantation and effect of its treatment on survival

Combined Thoracic and Abdominal Organ Transplantation: Special Considerations

Cardiorenal syndrome: Multi‐organ dysfunction involving the heart, kidney and vasculature

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