Ariyamuthu Venkatesh K, Cheng Xingxing S, Hippen Benjamin, Bloom Roy D, Acharya Deepak, Araj Faris, Gungor Ahmet B, Alhamad Tarek, Singh Neeraj, Anand Prince M, Gupta Gaurav, Akalin Enver, Molnar Miklos Z, Mete Mutlu, Ayvaci Mehmet U S, Doshi Mona, Tanriover Bekir
Division of Nephrology, University of Arizona, Tucson, AZ.
Division of Nephrology, Stanford University, Stanford, CA.
Transplantation. 2025 Jun 1;109(6):e317-e325. doi: 10.1097/TP.0000000000005251. Epub 2024 Nov 6.
The 2018 revision of the adult Heart Allocation Policy (aHAP) led to a notable increase in the rate of simultaneous heart-kidney transplants (SHKT) in the United States. However, this policy has faced criticism for its inability to enhance post-transplant survival rates or decrease mortality among SHKT recipients on the waitlist, although high-quality kidneys are used.
We analyzed data from the Organ Procurement and Transplantation Network, covering 1549 SHKT cases from 2015 to 2021. The study assessed 1-y post-transplant outcomes, including all-cause heart and kidney graft failures and adverse kidney outcomes such as end-stage kidney disease, significantly reduced kidney function or the need for retransplantation. Using a propensity score-matching approach, we compared 2 cohorts: patients treated before and after the policy implementation in October 2018.
The multivariable Cox proportional hazard models indicated a significant increase in mortality (hazard ratio [HR] 1.62; 95% confidence interval [CI], 1.10-2.37) and all-cause graft failures for both heart (HR 1.59; 95% CI, 1.08-2.33) and kidney (HR 1.39; 95% CI, 1.03-1.85) during the period after the new aHAP implementation. One year post-transplant, the incidence of adverse kidney outcomes was 6.8% under the new aHAP compared with 5.3% in the previous period among survivors ( P = 0.33).
The suboptimal outcomes of SHKT under the new aHAP, alongside its potential impacts on kidney-alone transplant candidates, suggest a need for regular monitoring of SHKT policies. This is crucial to ensure that the intentions of the Final Rule regarding equity and utility are effectively met.
2018年成人心脏分配政策（aHAP）修订后，美国心脏-肾脏联合移植（SHKT）率显著上升。然而，尽管使用了高质量的肾脏，但该政策因无法提高移植后生存率或降低等待名单上SHKT受者的死亡率而受到批评。
我们分析了器官获取与移植网络的数据，涵盖2015年至2021年的1549例SHKT病例。该研究评估了移植后1年的结局，包括全因心脏和肾脏移植物失败以及不良肾脏结局，如终末期肾病、肾功能显著下降或再次移植的需求。我们采用倾向评分匹配方法，比较了两个队列：2018年10月政策实施前后接受治疗的患者。
多变量Cox比例风险模型显示，新aHAP实施后，死亡率（风险比[HR]1.62；95%置信区间[CI]，1.10 - 2.37）以及心脏（HR 1.59；95% CI，1.08 - 2.33）和肾脏（HR 1.39；95% CI，1.03 - 1.85）的全因移植物失败率均显著增加。移植后1年，新aHAP下不良肾脏结局的发生率在幸存者中为6.8%，而前一时期为5.3%（P = 0.33）。
新aHAP下SHKT的次优结局及其对仅接受肾脏移植候选者的潜在影响表明，需要定期监测SHKT政策。这对于确保有效实现最终规则中关于公平和效用的意图至关重要。
