Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
J Card Fail. 2020 Jul;26(7):574-579. doi: 10.1016/j.cardfail.2020.03.002. Epub 2020 Mar 9.
In patients with reduced kidney function there are no established guidelines to suggest combined heart-kidney transplant (HKTx) versus sequential kidney transplant (SKTx) using preoperative value of estimated glomerular filtration (eGFR).
The United Network for Organ Sharing database was queried from 2000 to 2015 to evaluate survival of HKTx and SKTx population stratified by preoperative eGFR rate <45 mL/min. Aim of the study was to assess the eGFR rate that is most beneficial to perform a concomitant or a SKTx at time of transplant evaluation.
In our analysis, patients who required SKTx are recipients that, after heart transplantation, developed or worsened kidney insufficiency due to calcineurin inhibitor nephrotoxicity. In recipients with eGFR <30 or dialysis, a total of 545 received HKTx and 80 received SKTx. The median waiting time between heart and kidney transplant in SKTx group was 6 years. The overall post-transplant survival was 81% and 80% and 75% and 59% at 5 and 1 years for the HKTx and SKTx groups, respectively (P = .04). In recipients with eGFR from 30 to 44, a total of 107 received HKTx and 112 received SKTx. The median waiting time between heart and kidney transplant in SKTx group was 4 years. Overall post-transplant survival showed no statistically significant differences in HKTx group (n=107) compared with SKTx group (n=112) and was 90% and 95% at 1 year and 74% and 52% at 5 years, respectively (P = .4) .
To optimize organ and patient survival, eGFR value can be utilized to discern between HKTx versus SKTx in patients with decreased renal function at the time of heart transplantation. Patients with eGFR<30 or in dialysis presented better survival with HKTx, while both SKTx and HKTx are suitable for patients with eGFR between 30 and 45.
在肾功能降低的患者中，尚无既定的指南建议使用术前估算肾小球滤过率（eGFR）来选择心脏-肾脏联合移植（HKTx）与序贯肾脏移植（SKTx）。
2000 年至 2015 年，我们通过美国器官共享网络数据库（United Network for Organ Sharing database）对接受心脏移植的患者进行了分层分析，这些患者的术前 eGFR 率＜45 mL/min。本研究的目的是评估在移植评估时进行同时或 SKTx 的最有利 eGFR 率。
在我们的分析中，需要 SKTx 的患者是在心脏移植后因钙调磷酸酶抑制剂肾毒性而出现或恶化肾功能不全的受者。在 eGFR＜30 或透析的患者中，共有 545 例接受了 HKTx，80 例接受了 SKTx。SKTx 组中，心脏和肾脏移植之间的中位等待时间为 6 年。HKTx 和 SKTx 组的 5 年和 1 年总移植后生存率分别为 81%和 80%，75%和 59%（P=0.04）。在 eGFR 为 30 至 44 的患者中，共有 107 例接受了 HKTx，112 例接受了 SKTx。SKTx 组中，心脏和肾脏移植之间的中位等待时间为 4 年。在 HKTx 组（n=107）与 SKTx 组（n=112）之间，1 年的总移植后生存率无统计学差异，分别为 90%和 95%，5 年的生存率分别为 74%和 52%（P=0.4）。
为了优化器官和患者的生存率，可以利用 eGFR 值在心脏移植时辨别肾功能降低患者是进行 HKTx 还是 SKTx。eGFR＜30 或透析的患者接受 HKTx 生存率更好，而 eGFR 在 30 至 45 之间的患者适合接受 SKTx 和 HKTx。
