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Current Heart Failure Reports

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Open Access 17-01-2024 | Heart Transplantation | Review

Evolutions in Combined Heart-Kidney Transplant

Authors: Rashmi Jain, Michelle M. Kittleson

Published in: Current Heart Failure Reports | Issue 2/2024

Abstract

Purpose of Review

This review describes management practices, outcomes, and allocation policies in candidates for simultaneous heart-kidney transplantation (SHKT).

Recent Findings

In patients with heart failure and concomitant kidney disease, SHKT confers a survival advantage over heart transplantation (HT) alone in patients with dialysis dependence or an estimated glomerular filtration rate (eGFR) < 40 mL/min/1.73 m². However, when compared to kidney transplantation (KT) alone, SHKT is associated with worse patient and kidney allograft survival. In September 2023, the United Network of Organ Sharing adopted a new organ allocation policy, with strict eligibility criteria for SHKT and a safety net for patients requiring KT after HT alone.

Summary

While the impact of the policy change on SHKT outcomes remains to be seen, strategies to prevent and slow development of kidney disease in patients with heart failure and to prevent kidney dysfunction after HT and SHKT are necessary.

Schefold JC, Filippatos G, Hasenfuss G, Anker SD, von Haehling S. Heart failure and kidney dysfunction: epidemiology, mechanisms and management. Nat Rev Nephrol. 2016;12(10):610–23. https://doi.org/10.1038/nrneph.2016.113.CrossRefPubMed

Hillege HL, Nitsch D, Pfeffer MA, Swedberg K, McMurray JJV, Yusuf S, et al. Renal function as a predictor of outcome in a broad spectrum of patients with heart failure. Circulation. 2006;113(5):671–8. https://doi.org/10.1161/CIRCULATIONAHA.105.580506.CrossRefPubMed

OPTN: organ procurement & transplantation network: national data. https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/ Accessed 31 Oct 2023.

Awad MA, Czer LSC, Emerson D, Jordan S, De Robertis MA, Mirocha J, et al. Combined heart and kidney transplantation: clinical experience in 100 consecutive patients. J Am Heart Assoc. 2019;8(4):e010570. https://doi.org/10.1161/JAHA.118.010570.CrossRefPubMedPubMedCentral

Chen Q, Malas J, Gianaris K, Esmailian G, Emerson D, Megna D, et al. Simultaneous heart-kidney transplant in patients with borderline estimated glomerular filtration rate without dialysis dependency. Clin Transplant. 2023;37(8):e14986. https://doi.org/10.1111/ctr.14986.CrossRefPubMed

• Itagaki S, Toyoda N, Moss N, Mancini D, Egorova N, Mikami T, et al. Outcomes of simultaneous heart and kidney transplantation. J Am Coll Cardiol. 2023;81(8):729–40. https://doi.org/10.1016/j.jacc.2022.11.053. (A comprehensive analysis of outcomes after heart-kidney transplanation in the contemporary era.)CrossRefPubMed

•• Kittleson MM, Sharma KS, Brennan DC, Cheng XS, Chow SL, Colvin M, et al. Dual-organ transplantation: indications, evaluation, and outcomes for heart-kidney and heart-liver transplantation: a scientific statement from the American Heart Association. Circulation. 2023;148(7):622–36. https://doi.org/10.1161/CIR.0000000000001155. (This source describes the most updated current practices for heart-kidney and heart-liver transplantation.)

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;6(9):2348–57. https://doi.org/10.1016/j.ekir.2021.06.032.CrossRefPubMedPubMedCentral

Grupper A, Grupper A, Daly RC, Pereira NL, Hathcock MA, Kremers WK, et al. Renal allograft outcome after simultaneous heart and kidney transplantation. Am J Cardiol. 2017;120(3):494–9. https://doi.org/10.1016/j.amjcard.2017.05.006.CrossRefPubMed

10.

Shaw BI, Samoylova ML, Sanoff S, Barbas AS, Sudan DL, Boulware LE, et al. Need for improvements in simultaneous heart-kidney allocation: the limitation of pretransplant glomerular filtration rate. Am J Transplant. 2021;21(7):2468–78. https://doi.org/10.1111/ajt.16466.CrossRefPubMedPubMedCentral

11.

Weingarten N, Iyengar A, Herbst DA, Helmers M, Rekhtman D, Song C, et al. Heart–kidney transplant versus heart transplant in the obese: a propensity-matched analysis. Eur J Cardio-Thorac Surg. 2023;63(1):ezac563. https://doi.org/10.1093/ejcts/ezac563.CrossRef

12.

Malas J, Chen Q, Emerson D, Megna D, Catarino P, Czer L, et al. Heart retransplant recipients with renal dysfunction benefit from simultaneous heart-kidney transplantation. J Heart Lung Transplant. 2023;42(8):1045–53. https://doi.org/10.1016/j.healun.2023.04.010.CrossRefPubMed

13.

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;108(2):458–66. https://doi.org/10.1016/j.athoracsur.2019.02.012.CrossRefPubMed

14.

Raichlin E, Kushwaha SS, Daly RC, Kremers WK, Frantz RP, Clavell AL, et al. Combined heart and kidney transplantation provides an excellent survival and decreases risk of cardiac cellular rejection and coronary allograft vasculopathy. Transpl Proc. 2011;43(5):1871–6. https://doi.org/10.1016/j.transproceed.2011.01.190.CrossRef

15.

Sato T, Cheng R, Azarbal B, Kittleson M, Patel J, Czer L, et al. Combined heart and kidney transplantation—is there a protective effect against cardiac allograft vasculopathy using intravascular ultrasound? J Heart Lung Transplant. 2019;38(9):956–62. https://doi.org/10.1016/j.healun.2019.06.012.CrossRefPubMed

16.

Williams KA, Hart DNJ, Fabre JW, Morris PJ. Distribution and quantitation of HLA-ABC and DR (Ia) antigens on human kidney and other tissues. Transplantation. 1980;29(4):274–9.CrossRefPubMed

17.

Ahsan SA, Guha A, Gonzalez J, Bhimaraj A. Combined heart-kidney transplantation: indications, outcomes, and controversies. Methodist Debakey Cardiovasc J. 2022;18(4):11–8. https://doi.org/10.14797/mdcvj.1139.CrossRefPubMedPubMedCentral

18.

Mezrich JD, Yamada K, Lee RS, Mawulawde K, Benjamin LC, Schwarze ML, 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;76(4):625–31.

19.

Karamlou T, Welke KF, McMullan DM, Cohen GA, Gelow J, Tibayan FA, 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;147(1):456-61.e1. https://doi.org/10.1016/j.jtcvs.2013.09.017.CrossRefPubMed

20.

Nguyen V, Kransdorf E, Patel J, Kittleson M, Chang D, Czer L, et al. Predictors of renal graft failure in heart/kidney transplant recipients. J Heart Lung Transplant. 2020;39(4):S299–300. https://doi.org/10.1016/j.healun.2020.01.668.CrossRef

21.

Beetz O, Thies J, Weigle CA, Ius F, Winkler M, Bara C, 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;22(1):258. https://doi.org/10.1186/s12882-021-02430-x.CrossRefPubMedPubMedCentral

22.

Toinet T, Dominique I, Cholley I, Vanalderwerelt V, Goujon A, Paret F, et al. Renal outcome after simultaneous heart and kidney transplantation. Clin Transplant. 2019;33(7):e13615. https://doi.org/10.1111/ctr.13615.CrossRefPubMed

23.

Kobashigawa J, Dadhania DM, Farr M, Tang WHW, Bhimaraj A, Czer L, et al. Consensus conference on heart-kidney transplantation. Am J Transplant. 2021;21(7):2459–67. https://doi.org/10.1111/ajt.16512.CrossRefPubMed

24.

•• Swanner KS, Laura Messick, Eric. Establish eligibility criteria and safety net for heart-kidney and lung-kidney allocation, 2023.(This source delineates the updated organ allocation policy for heart-kidney transplantation.)

25.

Wiseman AC. Simultaneous liver-kidney transplant: long-term management (steroid withdrawal and safety net patients). Clin Liver Dis (Hoboken). 2019;13(6):176–9. https://doi.org/10.1002/cld.814.CrossRefPubMed

26.

Wilk AR, Booker SE, Stewart DE, Wiseman A, Gauntt K, Mulligan D, 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;21(11):3593–607. https://doi.org/10.1111/ajt.16761.CrossRefPubMed

27.

Beldhuis IE, Lam CSP, Testani JM, Voors AA, Van Spall HGC, ter Maaten JM, et al. Evidence-based medical therapy in patients with heart failure with reduced ejection fraction and chronic kidney disease. Circulation. 2022;145(9):693–712. https://doi.org/10.1161/CIRCULATIONAHA.121.052792.CrossRefPubMedPubMedCentral

28.

Hein AM, Scialla JJ, Edmonston D, Cooper LB, DeVore AD, Mentz RJ. Medical management of heart failure with reduced ejection fraction in patients with advanced renal disease. JACC Heart Fail. 2019;7(5):371–82. https://doi.org/10.1016/j.jchf.2019.02.009.CrossRefPubMedPubMedCentral

29.

Khan MS, Ahmed A, Greene SJ, Fiuzat M, Kittleson MM, Butler J, et al. Managing heart failure in patients on dialysis: state-of-the-art review. J Card Fail. 2023;29(1):87–107. https://doi.org/10.1016/j.cardfail.2022.09.013.CrossRefPubMed

30.

Mullens W, Martens P, Testani JM, Tang WHW, Skouri H, Verbrugge FH, et al. Renal effects of guideline-directed medical therapies in heart failure: a consensus document from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2022;24(4):603–19. https://doi.org/10.1002/ejhf.2471.CrossRefPubMed

31.

Heidenreich Paul A, Bozkurt B, Aguilar D, Allen Larry A, Byun Joni J, Colvin Monica M, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. J Am Coll Cardiol. 2022;79(17):e263–421. https://doi.org/10.1016/j.jacc.2021.12.012.CrossRefPubMed

32.

Cice G, Ferrara L, D’Andrea A, D’Isa S, Di Benedetto A, Cittadini A, et al. Carvedilol increases two-year survivalin dialysis patients with dilated cardiomyopathy: a prospective, placebo-controlled trial. J Am Coll Cardiol. 2003;41(9):1438–44. https://doi.org/10.1016/S0735-1097(03)00241-9.CrossRefPubMed

33.

Sharing UNfO. The new adult heart allocation policy takes effect this Thursday, 2018.

34.

Agdamag AC, Riad S, Maharaj V, Jackson S, Fraser M, Charpentier V, et al. Temporary mechanical circulatory support use and clinical outcomes of simultaneous heart/kidney transplant recipients in the pre– and post–heart allocation policy change eras. Transplantation. 2023;107(7):1605–14

35.

Francke M, Wolfson AM, Fong MW, Nattiv J, Pandya K, Kawaguchi ES, et al. New UNOS allocation system associated with no added benefit in waitlist outcomes and worse post-transplant survival in heart-kidney patients. J Heart Lung Transplant. 2023. https://doi.org/10.1016/j.healun.2023.06.018.CrossRefPubMed

36.

Ohira S, Okumura K, Pan S, Dhand A, Levine E, De La Pena CB, et al. Outcomes of combined heart and kidney transplantation under the new heart allocation policy: a united organ network for organ sharing database analysis. Circulation: Heart Fail. 2023;16(4):e010059. https://doi.org/10.1161/CIRCHEARTFAILURE.122.010059.CrossRef

37.

Shin M, Iyengar A, Helmers MR, Weingarten N, Patrick WL, Rekhtman D, et al. Decreased survival of simultaneous heart-kidney transplant recipients in the new heart allocation era. J Heart Lung Transplant. 2023. https://doi.org/10.1016/j.healun.2023.08.006.CrossRefPubMed

38.

Atkins J, Hess NR, Fu S, Read JM, Hajj JM, Ramu B, et al. Outcomes in patients with LVADs undergoing simultaneous heart-kidney transplantation. J Card Fail. 2022;28(11):1584–92. https://doi.org/10.1016/j.cardfail.2022.04.016.CrossRefPubMed

39.

Ruzza A, Czer LS, Trento A, Esmailian F. Combined heart and kidney transplantation: what is the appropriate surgical sequence? Interact Cardiovasc Thorac Surg. 2013;17(2):416–8. https://doi.org/10.1093/icvts/ivt172.CrossRefPubMedPubMedCentral

40.

Lutz AJ, Nagaraju S, Sharfuddin AA, Garcia JP, Saleem K, Mangus RS, et al. Simultaneous heart-kidney transplant with planned delayed implantation of the kidney graft after ex vivo perfusion. Transplantation. 2023;107(9):2043–46

41.

Ariyamuthu VK, Amin AA, Drazner MH, Araj F, Mammen PPA, Ayvaci M, et al. Induction regimen and survival in simultaneous heart-kidney transplant recipients. J Heart Lung Transplant. 2018;37(5):587–95. https://doi.org/10.1016/j.healun.2017.11.012.CrossRefPubMed

42.

Grimm M, Rinaldi M, Yonan NA, Arpesella G, Arizón Del Prado JM, Pulpón LA, et al. Superior prevention of acute rejection by tacrolimus vs. cyclosporine in heart transplant recipients—a large European Trial. Am J Transplant. 2006;6(6):1387–97. https://doi.org/10.1111/j.1600-6143.2006.01300.x.CrossRefPubMed

43.

Taylor DO, Barr ML, Radovancevic B, Renlund DG, Mentzer RM Jr, Smart FW, et al. A randomized, multicenter comparison of tacrolimus and cyclosporine immunosuppressive regimens in cardiac transplantation: decreased hyperlipidemia and hypertension with tacrolimus 1 2. J Heart Lung Transplant. 1999;18(4):336–45. https://doi.org/10.1016/S1053-2498(98)00060-6.CrossRefPubMed

44.

Ye F, Ying-Bin X, Yu-Guo W, Hetzer R. Tacrolimus versus cyclosporine microemulsion for heart transplant recipients: a meta-analysis. J Heart Lung Transplant. 2009;28(1):58–66. https://doi.org/10.1016/j.healun.2008.10.004.CrossRefPubMed

45.

Kobashigawa J, Miller L, Renlund D, Mentzer R, Alderman E, Bourge R, et al. A randomized active-controlled trial of mycophenolate mofetil in heart transplant recipients1. Transplantation. 1998;66(4):507–15

46.

Eisen HJ, Kobashigawa J, Starling RC, Pauly DF, Kfoury A, Ross H, et al. Everolimus versus mycophenolate mofetil in heart transplantation: a randomized, multicenter trial. Am J Transplant. 2013;13(5):1203–16. https://doi.org/10.1111/ajt.12181.CrossRefPubMed

47.

Eisen HJ, Tuzcu EM, Dorent R, Kobashigawa J, Mancini D, Valantine-von Kaeppler HA, et al. Everolimus for the prevention of allograft rejection and vasculopathy in cardiac-transplant recipients. N Engl J Med. 2003;349(9):847–58. https://doi.org/10.1056/NEJMoa022171.CrossRefPubMed

48.

Kobashigawa JA, Pauly DF, Starling RC, Eisen H, Ross H, Wang S-S, et al. Cardiac allograft vasculopathy by intravascular ultrasound in heart transplant patients: substudy from the everolimus versus mycophenolate mofetil randomized, multicenter trial. JACC: Heart Fail. 2013;1(5):389–99. https://doi.org/10.1016/j.jchf.2013.07.002.CrossRefPubMed

49.

Keogh A, Richardson M, Ruygrok P, Spratt P, Galbraith A, O’Driscoll G, et al. Sirolimus in de novo heart transplant recipients reduces acute rejection and prevents coronary artery disease at 2 years. Circulation. 2004;110(17):2694–700. https://doi.org/10.1161/01.CIR.0000136812.90177.94.CrossRefPubMed

50.

Andreassen AK, Andersson B, Gustafsson F, Eiskjær H, Rådegran G, Gude E, et al. Everolimus initiation and early calcineurin inhibitor withdrawal in heart transplant recipients: a randomized trial. Am J Transplant. 2014;14(8):1828–38. https://doi.org/10.1111/ajt.12809.CrossRefPubMed

51.

Barten MJ, Grahammer F. The enigma of heart-kidney transplantation. Transplantation. 2023;107(9):1877–1879

52.

Barten MJ, Sax B, Schopka S, Amarelli C, Epailly E, Natali B, et al. European multicenter study on the real-world use and clinical impact of extracorporeal photopheresis after heart transplantation. J Heart Lung Transplant. 2023;42(8):1131–9. https://doi.org/10.1016/j.healun.2023.03.005.CrossRefPubMed

53.

Budde K, Prashar R, Haller H, Rial MC, Kamar N, Agarwal A, et al. Conversion from calcineurin inhibitor– to belatacept-based maintenance immunosuppression in renal transplant recipients: a randomized phase 3b trial. J Am Soc Nephrol. 2021;32(12):3252–64

54.

Lombardi Y, François H. Belatacept in kidney transplantation: what are the true benefits? A systematic review. Front Med (Lausanne). 2022;9:942665. https://doi.org/10.3389/fmed.2022.942665.CrossRefPubMed

55.

Vincenti F, Rostaing L, Grinyo J, Rice K, Steinberg S, Gaite L, et al. Belatacept and long-term outcomes in kidney transplantation. N Engl J Med. 2016;374(4):333–43. https://doi.org/10.1056/NEJMoa1506027.CrossRefPubMed

56.

Launay M, Guitard J, Dorent R, Prevot Y, Prion F, Beaumont L, et al. Belatacept-based immunosuppression: a calcineurin inhibitor-sparing regimen in heart transplant recipients. Am J Transplant. 2020;20(2):553–63. https://doi.org/10.1111/ajt.15584.CrossRefPubMed

Title: Evolutions in Combined Heart-Kidney Transplant
Authors: Rashmi Jain
Michelle M. Kittleson
Publication date: 17-01-2024
Publisher: Springer US
Keywords: Heart Transplantation
Heart Transplantation
Heart Transplantation
Heart Transplantation
Heart Transplantation
Kidney Transplantation
Kidney Transplantation
Kidney Transplantation
Kidney Transplantation
Kidney Transplantation
Kidney Transplantation
Heart Failure
Chronic Kidney Disease
Published in: Current Heart Failure Reports / Issue 2/2024
Print ISSN: 1546-9530
Electronic ISSN: 1546-9549
DOI: https://doi.org/10.1007/s11897-024-00646-0

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