Cecillia Lui1, Charles D Fraser2, Xun Zhou2, Alejandro Suarez-Pierre2, Joshua C Grimm3, Robert Sd Higgins2, Kenton J Zehr2, Ahmet Kilic2. 1. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: clui6@jhmi.edu. 2. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 3. Division of Cardiac Surgery, University of Pennsylvania Hospital, Philadelphia, PA.
Abstract
BACKGROUND: The utilization of multi-organ transplantation in cardiac transplantation has steadily increased over the past several years. We sought to characterize the trends and outcomes in simultaneous heart and other organ transplantation compared to heart transplantation alone. METHODS: The UNOS database was queried for all adult patients (age ≥ 18) who underwent isolated heart transplantation or simultaneous heart-lung or heart-kidney transplantation from 1987-2016. Patients were stratified into three equal time intervals. Demographics and postoperative outcomes were compared. RESULTS: A total of 58,060 patients were identified with a distribution based on era. Dual organ recipients had more factors associated with increased operative risk including higher rates of diabetes, pulmonary hypertension, intensive care unit (ICU) admissions, and dialysis prior to transplantation. Heart-lung and heart-kidney recipients had decreased one-year survival compared to isolated heart recipients from 2007-2016. However, heart-kidney recipients had significantly increased five-year post-transplantation survival compared to isolated heart recipients with impaired renal function. For isolated heart transplants and heart-lung transplants, five-year survival rates improved over time, while five-year survival for heart-kidney recipients did not improve with time. CONCLUSIONS: We found a significantly increased five-year survival rate for heart-kidney transplant recipients compared to isolated heart transplant recipients with renal impairment. Lack of improvement in five-year post-operative outcomes for heart-kidney recipients in the setting of higher risk pre-transplant clinical characteristics suggests decreased selectivity regarding heart-kidney recipients. Continued scrutiny and evaluation of post-operative outcomes are required to ensure just and appropriate utilization of organs.
BACKGROUND: The utilization of multi-organ transplantation in cardiac transplantation has steadily increased over the past several years. We sought to characterize the trends and outcomes in simultaneous heart and other organ transplantation compared to heart transplantation alone. METHODS: The UNOS database was queried for all adult patients (age ≥ 18) who underwent isolated heart transplantation or simultaneous heart-lung or heart-kidney transplantation from 1987-2016. Patients were stratified into three equal time intervals. Demographics and postoperative outcomes were compared. RESULTS: A total of 58,060 patients were identified with a distribution based on era. Dual organ recipients had more factors associated with increased operative risk including higher rates of diabetes, pulmonary hypertension, intensive care unit (ICU) admissions, and dialysis prior to transplantation. Heart-lung and heart-kidney recipients had decreased one-year survival compared to isolated heart recipients from 2007-2016. However, heart-kidney recipients had significantly increased five-year post-transplantation survival compared to isolated heart recipients with impaired renal function. For isolated heart transplants and heart-lung transplants, five-year survival rates improved over time, while five-year survival for heart-kidney recipients did not improve with time. CONCLUSIONS: We found a significantly increased five-year survival rate for heart-kidney transplant recipients compared to isolated heart transplant recipients with renal impairment. Lack of improvement in five-year post-operative outcomes for heart-kidney recipients in the setting of higher risk pre-transplant clinical characteristics suggests decreased selectivity regarding heart-kidney recipients. Continued scrutiny and evaluation of post-operative outcomes are required to ensure just and appropriate utilization of organs.
Authors: Brian I Shaw; Mariya L Samoylova; Scott Sanoff; Andrew S Barbas; Debra L Sudan; L Ebony Boulware; Lisa M McElroy Journal: Am J Transplant Date: 2021-02-09 Impact factor: 9.369