Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN.
Division of Nephrology, Department of Medicine, University of Minnesota, Minneapolis, MN.
Transplantation. 2024 Feb 1;108(2):524-529. doi: 10.1097/TP.0000000000004781. Epub 2023 Sep 6.
Heart transplantation remains the most definitive therapy for qualified candidates with end-stage heart failure. Concomitant kidney disease is common in this population prompting an increase in simultaneous heart-kidney (SHK) transplantation in recent years. The goal of our study was to explore the effects of the 2018 heart allocation policy (HAP) change on candidate listing characteristics and compare survival rates at 1 y in patients that were supported with a left ventricular assist device (LVAD) pretransplant and underwent SHK or heart alone transplant (HAT).
We used data from the Scientific Registry of Transplant Recipients and identified all adults who underwent primary SHK or HAT between January 2010 and March 2022. Recipients supported with a durable LVAD and estimated glomerular filtration rate <60 mL/min/1.73 m 2 were selected (n = 309 SHK; 217 pre- and 92 post-HAP and n = 3,324 HAT; 2738 pre- and 586 post-HAP).
Difference in survival at 1 y did not reach statistical significance. Comparing the 1-y survival of SHK and HAT recipients who were bridged with LVAD pre-HAP, we found no significant difference ( P = 0.694). Adjusting for the same covariates in a multivariable model did not affect the results (SHK versus HAT hazard ratio 0.84 [0.51, 1.37]; P = 0.48). In contrast, SHK recipients supported with an LVAD who were listed and transplanted post-HAP change had significantly lower 1-y survival, when compared with HAT ( P = 0.037).
Our findings suggest that the HAP change had a potentially negative impact on the survival of select patients undergoing SHK transplant. Further research is warranted in this area.
心脏移植仍然是终末期心力衰竭合格患者的最有效治疗方法。在该人群中，同时存在肾脏疾病很常见，这促使近年来同时进行心脏-肾脏（SHK）移植的数量增加。我们研究的目的是探讨 2018 年心脏分配政策（HAP）变化对候选者列表特征的影响，并比较在移植前使用左心室辅助装置（LVAD）支持的患者中，接受 SHK 或单独心脏移植（HAT）的患者在 1 年时的生存率。
我们使用了移植受者科学登记处的数据，并确定了 2010 年 1 月至 2022 年 3 月期间接受原发性 SHK 或 HAT 的所有成年人。选择了使用耐用性 LVAD 和估计肾小球滤过率<60mL/min/1.73m 2 的患者（n=309 例 SHK；217 例为 HAP 前，92 例为 HAP 后；n=3324 例 HAT；2738 例为 HAP 前，586 例为 HAP 后）。
1 年时的生存率差异没有达到统计学意义。在比较 HAP 前使用 LVAD 桥接的 SHK 和 HAT 受者的 1 年生存率时，我们没有发现显著差异（P=0.694）。在多变量模型中调整相同的协变量也没有影响结果（SHK 与 HAT 的风险比为 0.84[0.51，1.37]；P=0.48）。相比之下，与 HAT 相比，在 HAP 后被列入名单并接受移植的 SHK 受者，1 年生存率显著降低（P=0.037）。
我们的研究结果表明，HAP 变化可能对接受 SHK 移植的特定患者的生存产生负面影响。在这一领域需要进一步研究。
