Combined Heart-Kidney Transplantation: Indications, Outcomes, and Controversies

Syed Adeel Ahsan; Ashrith Guha; Juan Gonzalez; Arvind Bhimaraj

doi:10.14797/mdcvj.1139

Combined Heart-Kidney Transplantation: Indications, Outcomes, and Controversies

Methodist DeBakey Cardiovascular Journal

Volume 18 (2022): Issue 4

By: Syed Adeel Ahsan , Ashrith Guha , Juan Gonzalez and Arvind Bhimaraj

Open Access

|Sep 2022

Abstract

Renal dysfunction, a prevalent comorbidity in advanced heart failure, is associated with significant morbidity and mortality after heart transplantation. In the recent era, the field of combined heart-kidney transplantation has experienced great success in the treatment of both renal and cardiac dysfunction in end-stage disease states, and the number of transplants has increased dramatically. In this review, we discuss appropriate indications and selection criteria, overall and organ-specific outcomes, and future perspectives in the field of combined heart-kidney transplantation.

References

Lund LH, Khush KK, Cherikh WS, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Heart Transplantation Report-2017; Focus Theme: Allograft ischemic time. J Heart Lung Transplant. 2017 Oct;36(10):1037-1046. doi: 10.1016/j.healun.2017.07.019
Open DOI Search in Google Scholar Back to article
Norman JC, Brook MI, Cooley DA, et al. Total support of the circulation of a patient with post-cardiotomy stone-heart syndrome by a partial artificial heart (ALVAD) for 5 days followed by heart and kidney transplantation. Lancet. 1978 May 27;1(8074):1125-7. doi: 10.1016/s0140-6736(78)90301-x
Open DOI Search in Google Scholar Back to article
Schaffer JM, Chiu P, Singh SK, Oyer PE, Reitz BA, Mallidi HR. Heart and combined heart-kidney transplantation in patients with concomitant renal insufficiency and end-stage heart failure. Am J Transplant. 2014 Feb;14(2):384-96. doi: 10.1111/ajt.12522
Open DOI Search in Google Scholar Back to article
Habib PJ, Patel PC, Hodge D, et al. Pre-orthotopic heart transplant estimated glomerular filtration rate predicts post-transplant mortality and renal outcomes: An analysis of the UNOS database. J Heart Lung Transplant. 2016 Dec;35(12):1471-1479. doi: 10.1016/j.healun.2016.05.028
Open DOI Search in Google Scholar Back to article
Karamlou T, Welke KF, McMullan DM, et al. 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 Jan;147(1):456-461.e1. doi: 10.1016/j.jtcvs.2013.09.017
Open DOI Search in Google Scholar Back to article
Organ Procurement & Transplantation Network [Internet]. Washington, DC: U.S. Department of Health & Human Services; c2022. National data; 2022 [cited 2022 Jul 23]. Available from: https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/
Search in Google Scholar Back to article
Melvinsdottir I, Foley DP, Hess T, et al. Heart and kidney transplant: should they be combined or subsequent? ESC Heart Fail. 2020 Oct;7(5):2734-2743. doi: 10.1002/ehf2.12864
Open DOI Search in Google Scholar Back to article
Lewis A, Koukoura A, Tsianos GI, Gargavanis AA, Nielsen AA, Vassiliadis E. Organ donation in the US and Europe: The supply vs demand imbalance. Transplant Rev (Orlando). 2021 Apr;35(2):100585. doi: 10.1016/j.trre.2020.100585
Open DOI Search in Google Scholar Back to article
Taiwo AA, Khush KK, Stedman MR, Zheng Y, Tan JC. Longitudinal changes in kidney function following heart transplantation: Stanford experience. Clin Transplant. 2018 Nov;32(11):e13414. doi: 10.1111/ctr.13414
Open DOI Search in Google Scholar Back to article
Mudge GH, Goldstein S, Addonizio LJ, et al. 24th Bethesda conference: Cardiac transplantation. Task Force 3: Recipient guidelines/prioritization. J Am Coll Cardiol. 1993 Jul;22(1):21-31. doi: 10.1016/0735-1097(93)90812-f
Open DOI Search in Google Scholar Back to article
Miller LW. Listing criteria for cardiac transplantation: results of an American Society of Transplant Physicians-National Institutes of Health conference. Transplantation. 1998 Oct 15;66(7):947-51. doi: 10.1097/00007890-199810150-00032
Open DOI Search in Google Scholar Back to article
Mehra MR, Kobashigawa J, Starling R, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates—2006. J Heart Lung Transplant. 2006 Sep;25(9):1024-42. doi: 10.1016/j.healun.2006.06.008
Open DOI Search in Google Scholar Back to article
Mehra MR, Canter CE, Hannan MM, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update. J Heart Lung Transplant. 2016 Jan;35(1):1-23. doi: 10.1016/j.healun.2015.10.023
Open DOI Search in Google Scholar Back to article
Gill J, Shah T, Hristea I, et al. Outcomes of simultaneous heart-kidney transplant in the US: a retrospective analysis using OPTN/UNOS data. Am J Transplant. 2009 Apr;9(4):844-52. doi: 10.1111/j.1600-6143.2009.02588.x
Open DOI Search in Google Scholar Back to article
Raichlin E, Kushwaha SS, Daly RC, et al. Combined heart and kidney transplantation provides an excellent survival and decreases risk of cardiac cellular rejection and coronary allograft vasculopathy. Transplant Proc. 2011 Jun;43(5):1871-6. doi: 10.1016/j.transproceed.2011.01.190
Open DOI Search in Google Scholar Back to article
Louis K, Bailly E, Macedo C, et al. IL-21 Driven Expansion And Reprogramming of T-BET Expressing B Cells During Antibody-Mediated Rejection of Kidney Transplants. Transpl Int. 2021 Aug 27;34(S1):5-404. doi: 10.1111/tri.13944
Open DOI Search in Google Scholar Back to article
Agarwal KA, Patel H, Agrawal N, Cardarelli F, Goyal N. Cardiac Outcomes in Isolated Heart and Simultaneous Kidney and Heart Transplants in the United States. Kidney Int Rep. 2021 Jul 14;6(9):2348-2357. doi: 10.1016/j.ekir.2021.06.032
Open DOI Search in Google Scholar Back to article
Kobashigawa J, Dadhania DM, Farr M, et al. Consensus conference on heart-kidney transplantation. Am J Transplant. 2021 Jul;21(7):2459-2467. doi: 10.1111/ajt.16512
Open DOI Search in Google Scholar Back to article
Tantisattamo E, Dafoe DC, Reddy UG, et al. Current Management of Patients With Acquired Solitary Kidney. Kidney Int Rep. 2019 Jul 11;4(9):1205-1218. doi: 10.1016/j.ekir.2019.07.001
Open DOI Search in Google Scholar Back to article
Theil G, Weigand K, Fischer K, Bialek J, Fornara P. Organ-Specific Monitoring of Solitary Kidney after Living Donation by Using Markers of Glomerular Filtration Rate and Urinary Proteins. Urol Int. 2021;105(11-12):1061-1067. doi: 10.1159/000515674
Open DOI Search in Google Scholar Back to article
Tsuda A, Ishimura E, Uedono H, et al. Comparison of the Estimated Glomerular Filtration Rate (eGFR) in Diabetic Patients, Non-Diabetic Patients and Living Kidney Donors. Kidney Blood Press Res. 2016;41(1):40-7. doi: 10.1159/000368545
Open DOI Search in Google Scholar Back to article
Issa N, Kukla A, Jackson S, et al. Comparison of cystatin C and creatinine-based equations for GFR estimation after living kidney donation. Transplantation. 2014 Oct 27;98(8):871-7. doi: 10.1097/TP.0000000000000129
Open DOI Search in Google Scholar Back to article
Angel-Korman A, Havasi A. Kidney Transplantation in Systemic Amyloidosis. Transplantation. 2020 Oct;104(10):2035-2047. doi: 10.1097/TP.0000000000003170
Open DOI Search in Google Scholar Back to article
Narula J, Bennett LE, DiSalvo T, Hosenpud JD, Semigran MJ, Dec GW. Outcomes in recipients of combined heart-kidney transplantation: multiorgan, same-donor transplant study of the International Society of Heart and Lung Transplantation/United Network for Organ Sharing Scientific Registry. Transplantation. 1997 Mar 27;63(6):861-7. doi: 10.1097/00007890-199703270-00012
Open DOI Search in Google Scholar Back to article
Hermsen JL, Nath DS, del Rio AM, et al. Combined heart-kidney transplantation: the University of Wisconsin experience. J Heart Lung Transplant. 2007 Nov;26(11):1119-26. doi: 10.1016/j.healun.2007.08.011
Open DOI Search in Google Scholar Back to article
Laufer G, Kocher A, Grabenwöger M, et al. Simultaneous heart and kidney transplantation as treatment for end-stage heart and kidney failure. Transplantation. 1997 Oct 27;64(8):1129-34. doi: 10.1097/00007890-199710270-00008
Open DOI Search in Google Scholar Back to article
Russo MJ, Rana A, Chen JM, et al. Pretransplantation patient characteristics and survival following combined heart and kidney transplantation: an analysis of the United Network for Organ Sharing Database. Arch Surg. 2009 Mar;144(3):241-6. doi: 10.1001/archsurg.2008.559
Open DOI Search in Google Scholar Back to article
Reich H, Dimbil S, Levine R, et al. Dual-organ transplantation in older recipients: outcomes after heart-kidney transplant versus isolated heart transplant in patients aged ≥65 years. Interact Cardiovasc Thorac Surg. 2019 Jan 1;28(1):45-51. doi: 10.1093/icvts/ivy202
Open DOI Search in Google Scholar Back to article
Trachiotis GD, Vega JD, Johnston TS, et al. Ten-year follow-up in patients with combined heart and kidney transplantation. J Thorac Cardiovasc Surg. 2003 Dec;126(6):2065-71. doi: 10.1016/j.jtcvs.2003.07.009
Open DOI Search in Google Scholar Back to article
Chou AS, Habertheuer A, Chin AL, Sultan I, Vallabhajosyula P. Heart-Kidney and Heart-Liver Transplantation Provide Immunoprotection to the Cardiac Allograft. Ann Thorac Surg. 2019 Aug;108(2):458-466. doi: 10.1016/j.athoracsur.2019.02.012.
Open DOI Search in Google Scholar Back to article
Williams KA, Hart DN, Fabre JW, Morris PJ. Distribution and quantitation of HLA-ABC and DR (Ia) antigens on human kidney and other tissues. Transplantation. 1980 Apr;29(4):274-79. doi: 10.1097/00007890-198004000-00002
Open DOI Search in Google Scholar Back to article
Mezrich JD, Yamada K, Lee RS, et al. Induction of tolerance to heart transplants by simultaneous cotransplantation of donor kidneys may depend on a radiation-sensitive renal-cell population. Transplantation. 2003 Aug 27;76(4):625-31. doi: 10.1097/01.TP.0000079926.80833.42
Open DOI Search in Google Scholar Back to article
Czer LSC, Ruzza A, Vespignani R, et al. Survival and allograft rejection rates after combined heart and kidney transplantation in comparison with heart transplantation alone. Transplant Proc. 2011 Dec;43(10):3869-76. doi: 10.1016/j.transproceed.2011.08.095
Open DOI Search in Google Scholar Back to article
Pinderski LJ, Kirklin JK, McGiffin D, et al. Multi-organ transplantation: is there a protective effect against acute and chronic rejection? J Heart Lung Transplant. 2005 Nov;24(11):1828-33. doi: 10.1016/j.healun.2005.03.015
Open DOI Search in Google Scholar Back to article
Sato T, Cheng R, Azarbal B, et al. Combined heart and kidney transplantation-Is there a protective effect against cardiac allograft vasculopathy using intravascular ultrasound? J Heart Lung Transplant. 2019 Sep;38(9):956-962. doi: 10.1016/j.healun.2019.06.012
Open DOI Search in Google Scholar Back to article
Shaw BI, Sudan DL, Boulware LE, McElroy LM. Striking a Balance in Simultaneous Heart Kidney Transplant: Optimizing Outcomes for All Wait-Listed Patients. J Am Soc Nephrol. 2020 Aug;31(8):1661-1664. doi: 10.1681/ASN.2020030336
Open DOI Search in Google Scholar Back to article
Cheng XS, Khush KK, Wiseman A, Teuteberg J, Tan JC. To kidney or not to kidney: Applying lessons learned from the simultaneous liver-kidney transplant policy to simultaneous heart-kidney transplantation. Clin Transplant. 2020 Jun;34(6):e13878. doi: 10.1111/ctr.13878
Open DOI Search in Google Scholar Back to article
Wang TJ, Lin CH, Wei HJ, Wu MJ. Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study. J Clin Med. 2020 Jul 31;9(8):2455. doi: 10.3390/jcm9082455
Open DOI Search in Google Scholar Back to article
Grupper A, Grupper A, Daly RC, et al. Renal Allograft Outcome After Simultaneous Heart and Kidney Transplantation. Am J Cardiol. 2017 Aug 1;120(3):494-499. doi: 10.1016/j.amjcard.2017.05.006
Open DOI Search in Google Scholar Back to article
Beetz O, Thies J, Weigle CA, et al. Simultaneous heart-kidney transplantation results in respectable long-term outcome but a high rate of early kidney graft loss in high-risk recipients - a European single center analysis. BMC Nephrol. 2021 Jul 9;22(1):258. doi: 10.1186/s12882-021-02430-x
Open DOI Search in Google Scholar Back to article
Kebschull L, Schleicher C, Palmes D, et al. Renal graft outcome in combined heart-kidney transplantation compared to kidney transplantation alone: a single-center, matched-control study. Thorac Cardiovasc Surg. 2012 Feb;60(1):57-63. doi: 10.1055/s-0031-1299574
Open DOI Search in Google Scholar Back to article
Toinet T, Dominique I, Cholley I, et al. Renal outcome after simultaneous heart and kidney transplantation. Clin Transplant. 2019 Jul;33(7):e13615. doi: 10.1111/ctr.13615
Open DOI Search in Google Scholar Back to article
Organ Procurement & Transplantation Network [Internet]. Washington, DC: U.S. Department of Health & Human Services; c2022. Ethical implications of multi organ transplants; 2019 [cited 2022 Jul 23]. Available from: https://optn.transplant.hrsa.gov/policies-bylaws/public-comment/ethical-implications-of-multi-organ-transplants
Search in Google Scholar Back to article
Grupper A, Grupper A, Daly RC, et al. Kidney transplantation as a therapeutic option for end-stage renal disease developing after heart transplantation. J Heart Lung Transplant. 2017 Mar;36(3):297-304. doi: 10.1016/j.healun.2016.08.004
Open DOI Search in Google Scholar Back to article
Lonze BE, Warren DS, Stewart ZA, et al. Kidney transplantation in previous heart or lung recipients. Am J Transplant. 2009 Mar;9(3):578-85. doi: 10.1111/j.1600-6143.2008.02540.x
Open DOI Search in Google Scholar Back to article
Organ Procurement & Transplantation Network [Internet]. Washington, DC: U.S. Department of Health & Human Services; c2022. Simultaneous Liver Kidney (SLK) Allocation Policy; 2015 [cited 2022 Aug 1]. Available from: https://optn.transplant.hrsa.gov/media/1192/0815-12_SLK_Allocation.pdf
Search in Google Scholar Back to article
Wilk AR, Booker SE, Stewart DE, et al. Developing simultaneous liver-kidney transplant medical eligibility criteria while providing a safety net: A 2-year review of the OPTN’s allocation policy. Am J Transplant. 2021 Nov;21(11):3593-3607. doi: 10.1111/ajt.16761
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.14797/mdcvj.1139 | Journal eISSN: 1947-6108

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Language: English

Page range: 11 - 18

Submitted on: May 21, 2022

Accepted on: Jul 8, 2022

Published on: Sep 6, 2022

Published by: Houston Methodist DeBakey Heart & Vascular Center

In partnership with: Paradigm Publishing Services

Keywords:

orthotopic heart transplantation,

deceased donor kidney transplantation,

chronic kidney disease,

heart-kidney transplantation,

transplant

© 2022 Syed Adeel Ahsan, Ashrith Guha, Juan Gonzalez, Arvind Bhimaraj, published by Houston Methodist DeBakey Heart & Vascular Center
This work is licensed under the Creative Commons Attribution-NonCommercial 4.0 License.

Volume 18 (2022): Issue 4