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Publications

Journal Article Ahead of print

PubMed: 42171542 DOI: 10.1016/j.jchf.2026.103115

10-Year Survival and Renal Outcomes After Simultaneous Heart-Kidney Transplantation in Heart Retransplant Recipients.

JACC Heart Fail

Authors: Ameesh Isath, Naoki Tadokoro, Felix Schoenrath, Milica Vukićević, Vanessa Faria, Tanujit Dey, Mark Godding, Michael M Givertz, Akinobu Itoh, Mandeep R Mehra

Affiliations

  • Mass General Brigham Heart and Vascular Institute, Harvard Medical School, Boston, Massachusetts, USA.
  • Division of Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Mass General Brigham Heart and Vascular Institute, Harvard Medical School, Boston, Massachusetts, USA; Department of Cardiothoracic and Vascular Surgery, German Heart Center of Charité, Berlin, Germany.
  • Mass General Brigham Heart and Vascular Institute, Harvard Medical School, Boston, Massachusetts, USA; Cardiac Surgery Clinic, University Clinical Center of Serbia, Belgrade, Serbia.
  • Center for Surgery and Public Health, Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Mass General Brigham Heart and Vascular Institute, Harvard Medical School, Boston, Massachusetts, USA.

Abstract

BACKGROUND

Renal dysfunction is common in heart retransplant (re-HT) candidates and adversely influences outcomes. Although simultaneous heart-kidney transplantation (SHKT) is established in primary transplantation for severe renal dysfunction, its long-term benefit in the re-HT setting remains incompletely defined.

OBJECTIVES

This study sought to evaluate 10-year survival and renal trajectories after SHKT compared with isolated re-HT.

METHODS

Adult patients undergoing re-HT (2000-2024) were identified from the UNOS (United Network for Organ Sharing) registry and categorized as isolated re-HT or simultaneous heart-kidney retransplantation (re-SHKT). The primary outcome was 10-year survival. Secondary outcomes evaluated renal outcomes, rejection, and cardiac allograft vasculopathy. Multivariable Cox regression and Fine-Gray competing risk models were used to adjust for recipient, donor, and era-related covariates.

RESULTS

Among 1,378 re-HT recipients, 304 (22%) underwent re-SHKT. Despite worse baseline renal function, re-SHKT was associated with improved 10-year survival (71.2% vs 59.1%, respectively; adjusted HR: 0.51; 95% CI: 0.38-0.70; P < 0.001). Survival benefit was observed in recipients with a pretransplant estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m 2 but not in those recipients with eGFR ≥45 mL/min/1.73 m 2. Isolated re-HT recipients with baseline renal impairment (eGFR <45 mL/min/1.73 m 2) demonstrated a graded increase in subsequent kidney transplantation and death before rescue transplantation. Re-SHKT was associated with an 84% reduction in subsequent kidney transplantation and fewer treated rejection episodes.

CONCLUSIONS

In re-HT recipients, SHKT was associated with sustained 10-year survival benefit and favorable renal trajectories, particularly in patients with moderate to severe renal dysfunction. These findings support dual-organ allocation in selected re-HT candidates with moderate to severe renal dysfunction.

MeSH

Heart Failure, Heart, Kidney, Kidney Transplantation, Transplantation