Abstract 14245: Heart Re-Transplant Recipients Fare Better with Concurrent Kidney Transplantation than with Heart Re-Transplant Alone
Introduction: Heart re-transplant (HRT) recipients comprise an increasing proportion of heart transplant recipients. Such patients have an increased burden of comorbidities including kidney disease, yet the impact of concurrent kidney transplant (KT) has not been well-studied.
Hypothesis: Patients undergoing HRT with concurrent kidney transplantation (HRT-KT) would have worse survival than patients undergoing HRT alone.
Methods: A retrospective study of the United Network of Organ Sharing (UNOS) database was performed for HRT recipients from 1987 to 2011.
Results: There were 1660 HRTs; 116 (7%) had a concurrent KT. Median age at transplant was 43yrs (IQR 20, 55). Those with HRT-KT were older (47 [IQR 34, 57] vs 43 [IQR 19, 55] yrs, p=0.002), had a higher proportion with eGFR<30 ml/min/1.73m2 or on dialysis (71% vs 21%, OR 9.3 [95% CI 6.0-14.4], p<0.001), higher prevalence of known diabetes (21% vs 8%, OR 3.5 [95% CI 2.1-6.0], p<0.001), longer waiting times (89 [IQR 40, 268] vs 64 [IQR 13, 197] days, p=0.001), and longer intervals since prior heart transplant (9.3 [IQR 4.1, 12.7] vs 5.6 [IQR 1.7, 9.6] yrs, p<0.001). Panel reactive antibodies were elevated (PRA>10%) in a similar proportion of HRT-KT and HRT alone recipients (24% vs 22%, p=0.585). Median survival in HRT-KT was longer than HRT alone (10.5 [95% CI 6.8-14.2] vs 6.7 [95% CI 5.9-7.4] yrs, p=0.005; Figure 1a). Of the 317 patients with eGFR<30 or on dialysis, median survival was longer in the HRT-KT group (n=74) as compared with HRT alone (n=243) (9.9 [95% CI 6.5-13.4] vs 2.6 [95% CI 1.0-4.2] yrs, p<0.001; Figure 1b).
Conclusions: In patients undergoing HRT, concurrent KT recipients had better survival than HRT alone recipients. This survival benefit is seen despite older age, a higher burden of diabetes, longer waiting time, and a similar burden of presensitization in those with HRT-KT versus HRT alone. In candidates for HRT, kidney failure should not preclude consideration for HRT in those eligible for concurrent KT.
- © 2012 by American Heart Association, Inc.