Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar;167(3):1064-1076.e2.
doi: 10.1016/j.jtcvs.2023.07.012. Epub 2023 Jul 21.

Improved waitlist and comparable post-transplant outcomes in simultaneous heart-kidney transplantation under the 2018 heart allocation system

Yeahwa Hong  1 , Nicholas R Hess  2 , Luke A Ziegler  2 , Gavin W Hickey  3 , Jessica H Huston  3 , Michael A Mathier  3 , Dennis M McNamara  3 , Mary E Keebler  3 , Hernando Gómez  4 , David J Kaczorowski  5
Affiliations

Improved waitlist and comparable post-transplant outcomes in simultaneous heart-kidney transplantation under the 2018 heart allocation system

Yeahwa Hong et al. J Thorac Cardiovasc Surg. 2024 Mar.

Abstract

Objective: This study aimed to investigate the clinical trends and the impact of the 2018 heart allocation policy change on both waitlist and post-transplant outcomes in simultaneous heart-kidney transplantation in the United States.

Methods: The United Network for Organ Sharing registry was queried to compare adult patients before and after the allocation policy change. This study included 2 separate analyses evaluating the waitlist and post-transplant outcomes. Multivariable analyses were performed to determine the 2018 allocation system's risk-adjusted hazards for 1-year waitlist and post-transplant mortality.

Results: The initial analysis investigating the waitlist outcomes included 1779 patients listed for simultaneous heart-kidney transplantation. Of these, 1075 patients (60.4%) were listed after the 2018 allocation policy change. After the policy change, the waitlist outcomes significantly improved with a shorter waitlist time, lower likelihood of de-listing, and higher likelihood of transplantation. In the subsequent analysis investigating the post-transplant outcomes, 1130 simultaneous heart-kidney transplant recipients were included, where 738 patients (65.3%) underwent simultaneous heart-kidney transplantation after the policy change. The 90-day, 6-month, and 1-year post-transplant survival and complication rates were comparable before and after the policy change. Multivariable analyses demonstrated that the 2018 allocation system positively impacted risk-adjusted 1-year waitlist mortality (sub-hazard ratio, 0.66, 95% CI, 0.51-0.85, P < .001), but it did not significantly impact risk-adjusted 1-year post-transplant mortality (hazard ratio, 1.03; 95% CI, 0.72-1.47, P = .876).

Conclusions: This study demonstrates increased rates of simultaneous heart-kidney transplantation with a shorter waitlist time after the 2018 allocation policy change. Furthermore, there were improved waitlist outcomes and comparable early post-transplant survival after simultaneous heart-kidney transplantation under the 2018 allocation system.

Keywords: adverse events; heart allocation; renal failure; simultaneous heart-kidney transplantation; survival.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Statement

D.J.K. received consultant and speaking fees from Medtronic and Abiomed. There are no direct conflicts of interest as it relates to this manuscript. All other authors reported no conflicts of interest.

The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Competing risk regression analysis within 1 year of waitlisting. A, Cumulative incidence of transplantation. B, Cumulative incidence of de-listing due to death or clinical deterioration (CI = 95%).
FIGURE 2.
FIGURE 2.
Unadjusted Kaplan–Meier estimates for survival after SHK transplantation stratified by allocation policy change.
FIGURE 3.
FIGURE 3.
Summary of the study design and key findings of the present UNOS analysis. The 2018 allocation system is associated with increased rates of SHK transplantation with improved waitlist outcomes and comparable early post-transplant survival. SHK, Simultaneous heart-kidney; UNOS, United Network for Organ Sharing; ESRD, End-stage kidney disease.
FIGURE E1.
FIGURE E1.
Total number (A) and proportion (B) of patients waitlisted for SHK transplantation among all patients listed for isolated heart transplantation stratified by allocation policy change. Prepolicy change: October 18, 2014, to June 30, 2017. Postpolicy change: October 18, 2018, to June 30, 2021.
FIGURE E2.
FIGURE E2.
Total number (A) and proportion (B) of SHK transplant recipients among all isolated heart transplant recipients stratified by allocation policy change. Prepolicy change: October 18, 2014, to June 30, 2017. Postpolicy change: October 18, 2018, to June 30, 2021.
FIGURE E3.
FIGURE E3.
Kaplan–Meier estimates for 1-year overall survival from the time of initial waitlisting stratified by allocation policy change.
See this image and copyright information in PMC

References

    1. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Stroke Statistics-2017 update: a report from the American Heart Association [published correction appears in Circulation. 2017;135:e646] [published correction appears in Circulation. 2017;136:e196]. Circulation. 2017; 135:e146–603. 10.1161/CIR.0000000000000485 - DOI - PMC - PubMed
    1. Leebeek FWG, Muslem R. Bleeding in critical care associated with left ventricular assist devices: pathophysiology, symptoms, and management. Hematology Am Soc Hematol Educ Program. 2019;2019:88–96. 10.1182/hematology.2019000067 - DOI - PMC - PubMed
    1. Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011;8:30–41. 10.1038/nrcardio.2010.165 - DOI - PMC - PubMed
    1. Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nat Rev Cardiol. 2016;13:368–78. 10.1038/nrcardio.2016.25 - DOI - PMC - PubMed
    1. Khush KK, Cherikh WS, Chambers DC, Harhay MO, Hayes D Jr, Hsich E, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth Adult Heart Transplantation Report - 2019; focus theme: donor and recipient size match [published correction appears in J Heart Lung Transplant. 2020;39:91]. J Heart Lung Transplant. 2019;38:1056–66. 10.1016/j.healun.2019.08.004 - DOI - PMC - PubMed

Publication types