AUTHOR=Catalano Michael A. , Pupovac Stevan , Jhaveri Kenar D. , Stevens Gerin R. , Hartman Alan R. , Yu Pey-Jen 

TITLE=Simultaneous Heart-Kidney Transplant—Does Hospital Experience With Heart Transplant or Kidney Transplant Have a Greater Impact on Patient Outcomes?

JOURNAL=Transplant International

VOLUME=Volume 36 - 2023

YEAR=2023

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.10854

DOI=10.3389/ti.2023.10854

ISSN=1432-2277

ABSTRACT=Background: High institutional transplant volume is associated with improved outcomes in isolated heart and kidney transplant. However, little is known regarding the impact of institutional experience on outcomes in simultaneous heart-kidney transplant (SHKT). The aim of this study was to assess trends and outcomes of SHKT nationally, as well as the impact of institutional heart and kidney transplant volume on survival for SHKT patients.

Methods: All adult patients (age ≥18) who underwent SHKT between 2005 - 2019 were identified using the United Network for Organ Sharing (UNOS) database. Annual institutional volumes in single organ heart or kidney transplant were determined. Univariate and multivariable analyses were conducted to assess the impact of demographics, comorbidities, and institutional transplant volumes on 1-year survival.

Results: There were 1564 SHKT identified, increasing from 54 in 2005 to 221 in 2019. In centers performing SHKT, median annual heart transplant volume was 35.0 (IQR 24.0-56.0) and median annual kidney transplant volume was 166.0 (IQR 89.5-224.0). One-year survival was 88.4%. In multivariable analysis, increasing annual heart transplant volume was associated with improved 1-year survival. Contrarily, annual kidney transplant volume was not associated with survival. Increasing donor age, dialysis at transplant, ischemic times, and total bilirubin were independently associated with reduced 1-year survival.   

Conclusion: Higher institutional heart transplant volume is associated with improved survival in SHKT. A similar association was not identified for kidney transplant volume. This suggests that SHKT outcomes are influenced by individual center heart transplant experience.  High volume heart transplant centers may be better equipped with managing SHKT patients.