Okumura Kenji, Ohira Suguru, Misawa Ryosuke, Nishida Seigo, Lansman Steven, Dhand Abhay
From the Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY.
Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY.
Ann Surg Open. 2025 Jun 13;6(2):e582. doi: 10.1097/AS9.0000000000000582. eCollection 2025 Jun.
To assess the outcomes of a pair of kidneys from a single donor used for simultaneous heart-kidney transplantation (SHKT) or kidney after heart transplantation (KAH).
An Increase in kidney dysfunction among heart transplant candidates has led to an increased need for SHKT and KAH. The risk of early kidney graft loss and mortality is higher in SHKT compared with kidney-alone recipients.
Among adult kidney transplant recipients from Oct 2014 to Oct 2022, outcomes were compared between paired kidney-alone SHKT and kidney-alone KAH. Paired kidney models were used to mitigate differences among donor risk factors. Differential graft years were calculated using restricted mean survival analysis.
A total of 1220 pairs of kidney-alone and SHKT recipients and 441 pairs of kidney-alone and KAH recipients were identified. Among the paired donor kidneys, graft survival was significantly lower in SHKT recipients compared with kidney-alone recipients at 1-year post-transplant (96.1% 89.3%; < 0.001) and at 3-year post-transplant (83.9% 78.8%; < 0.001). This resulted in lower mean graft years [SHKT (3.98 years, standard error = 0.06) kidney-alone (4.55 years, standard error = 0.04); < 0.001] and an additional loss of 57 kidney graft years per 100 transplants ( < 0.01) during the study period. There was no difference in graft survival of paired kidneys in kidney-alone KAH recipients with additional loss of 17 kidney graft years per 100 transplants ( = 0.20).
Optimal recipient selection for kidney after heart transplant under the new safety-net policy may help mitigate the significant risk of kidney graft failure among SHKT recipients.
评估来自单一供体的一对肾脏用于同期心脏-肾脏移植（SHKT）或心脏移植后肾脏移植（KAH）的结果。
心脏移植受者中肾功能障碍的增加导致对SHKT和KAH的需求增加。与单纯肾脏移植受者相比，SHKT中早期肾移植丢失和死亡的风险更高。
在2014年10月至2022年10月的成年肾移植受者中，比较了配对的单纯肾脏SHKT和单纯肾脏KAH的结果。使用配对肾脏模型来减轻供体风险因素之间的差异。使用受限平均生存分析计算差异移植年数。
共识别出1220对单纯肾脏和SHKT受者以及441对单纯肾脏和KAH受者。在配对的供体肾脏中，SHKT受者的移植肾存活率在移植后1年（96.1%对89.3%；P<0.001）和移植后3年（83.9%对78.8%；P<0.001）时显著低于单纯肾脏受者。这导致平均移植年数更低[SHKT（3.98年，标准误=0.06）对单纯肾脏（4.55年，标准误=0.04）；P<0.001]，并且在研究期间每100例移植中额外损失57个移植肾年（P<0.01）。单纯肾脏KAH受者中配对肾脏的移植肾存活率没有差异，每100例移植中额外损失17个移植肾年（P=0.20）。
在新的安全网政策下，为心脏移植后肾脏移植选择最佳受者可能有助于减轻SHKT受者中肾移植失败的重大风险。
