Savla Jill, Lin Kimberly Y, Pradhan Madhura, Ruebner Rebecca L, Rogers Rachel S, Haskins Somaly S, Owens Anjali T, Abt Peter, Gaynor J William, Shaddy Robert E, Rossano Joseph W
Department of Pediatrics, The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (J.S., K.Y.L., M.P., R.L.R., R.S.R., S.S.H., A.T.O., P.A., W.G., R.E.S., J.W.R.).
J Am Heart Assoc. 2015 Dec 11;4(12):e002435. doi: 10.1161/JAHA.115.002435.
Heart retransplant (HRT) recipients represent a growing number of transplant patients. The impact of concurrent kidney transplants (KTs) in this population has not been well studied. We tested the hypothesis that recipients of HRT with concurrent KT (HRT-KT) would have worse survival than recipients of HRT alone.
A retrospective analysis of the United Network of Organ Sharing database was performed for all patients undergoing HRT from 1987 to 2011. There were 1660 HRT patients, of which 116 (7%) received concurrent KT. Those who received HRT-KT had older age, longer wait-list time, worse kidney function, and more known diabetes. Survival among recipients of HRT-KT was significantly better than that of recipients of HRT alone (P=0.005). A subgroup of 323 HRT patients with severe kidney dysfunction (estimated glomerular filtration rate <30 mL/min per 1.73 m(2) or on dialysis) was studied in more detail, and 76 (24%) received concurrent KT. Those on dialysis at the time of HRT had better survival with versus without concurrent KT (P<0.0001). On multivariable analysis, concurrent KT was independently associated with better outcomes for all patients with HRT and for the subgroup of patients with severe kidney dysfunction.
Recipients of HRT-KT have better survival than recipients of HRT alone. Further research is needed to determine which HRT patients may benefit the most from concurrent KT.
心脏再次移植（HRT）受者在移植患者中所占比例日益增加。对于这一人群中同时进行肾脏移植（KT）的影响尚未得到充分研究。我们检验了这样一个假设，即同时进行KT的HRT受者（HRT-KT）的生存率会比单纯HRT受者更差。
对1987年至2011年期间接受HRT的所有患者进行了器官共享联合网络数据库的回顾性分析。共有1660例HRT患者，其中116例（7%）同时接受了KT。接受HRT-KT的患者年龄更大、等待名单时间更长、肾功能更差且已知糖尿病患者更多。HRT-KT受者的生存率显著高于单纯HRT受者（P = 0.005）。对323例严重肾功能不全（估计肾小球滤过率<30 mL/（min·1.73 m²）或正在接受透析）的HRT患者亚组进行了更详细的研究，其中76例（24%）同时接受了KT。HRT时正在接受透析的患者，同时进行KT与未进行KT相比生存率更高（P<0.0001）。多变量分析显示，对于所有HRT患者以及严重肾功能不全患者亚组，同时进行KT与更好的预后独立相关。
HRT-KT受者的生存率高于单纯HRT受者。需要进一步研究以确定哪些HRT患者可能从同时进行KT中获益最大。
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