Kidney Week

Abstract: SU-OR49

Renal Graft Outcomes in Simultaneous Kidney-Heart Transplant Recipients: Analysis of the UNOS Database from 1987-2018

Session Information

• Challenges in Clinical Transplantation
  October 25, 2020 | Location: Simulive
  Abstract Time: 05:00 PM - 07:00 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Agarwal, Krishna A., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Krishna A. Agarwal, MD, MBBS, FASN



Dr. Agarwal is a nephrology fellow at Beth Israel Deaconess Medical Center. He is originally from Delhi, India, where he completed medical school at Vardhman Mahavir Medical College. He moved to Boston in 2014 to pursue a Research Fellowship in Prof. Terry Strom’s Immunology lab at Harvard and then internal medicine residency at Baystate Medical Center in Western Massachusetts. His ultimate clinical interest lies in Transplant Nephrology with a research focus in long term allograft survival and transplant tolerance. When not working, Dr. Agarwal enjoys spending time with his wife and daughter.

• Patel, Het, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Het Patel,

• Cardarelli, Francesca, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Francesca Cardarelli,

• Agrawal, Nikhil, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Nikhil Agrawal,

Group or Team Name

• BIDMC

Background

Simultaneous kidney and heart transplants (SKHT) are employed for patients with both end-stage heart failure and severely impaired kidney function. Renal outcomes in such recipients have been described, albeit in single-center cohorts. We analyzed the United Network for Organ Sharing (UNOS) dataset comprising of 1702 simultaneous kidney-heart transplant recipients since 1987.

Methods

This is a retrospective analysis of SKHT recipients in the UNOS dataset who received transplants between October 1987 and December 2018. We compared the incidence and risk factors of renal allograft loss in SKHT recipients versus deceased donor kidney (DDKT) alone recipients. The Student t-test or Kruskal Wallis tests were used to compare continuous variables, and the Chi2 test for categorical variables between groups. Cox regression hazard model was used to study the factors associated with graft failure.

Results

SKHT recipients were mostly white, males, 5-years older than DDKT recipients. The SKHT donors were younger than DDKT donors, predominantly white males who died from a CVA. Five year patient survival was similar in both the groups ( 80%) but 1-year mortality was 3 times higher in the SKHT group (12.5%) than DDKT (4.6%). Nearly 20% recipients in both groups died with a functioning graft. Renal graft survival in SKHT group was lower in the first year but equalized with DDKT group over 5 years. Cox regression analysis revealed male gender [HR 2.14], pre-emptive renal transplantation [HR 6.57] and HLA mismatch >4 [5.60] as significant risk factors for renal graft failure in SKHT recipients as compared to DDKT recipients at 4 years. Predominant cause of graft failure in SKHT recipients was primary failure (36%) and in DDKT recipients was acute rejection (26%).

Conclusion

This is the largest analysis of the UNOS database till date to describe risk factors associated with renal graft loss in SKHT recipients. We also showed that 38% of grafts that fail in SKHT recipients, failed in the first year following transplant and primary failure was the predominant cause. Our analysis provides much needed data to policy makers for future combined organ allocation policies.