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Combined Heart Kidney Transplantation Versus Heart Transplant in Patients with Renal Failure: Contemporary Insights and Future Perspectives

  • Heart Failure (HJ Eisen, Section Editor)
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Abstract

Purpose of Review

In this review, we aim to outline the criteria regarding the evaluation of patients with chronic renal disease (CKD) awaiting heart transplantation and discuss the outcomes of combined heart/kidney transplantation. Herein, we also review pathophysiology and risk factors that predispose to chronic kidney disease (CKD) and acute kidney injury (AKI) in patients with HF and after OHT.

Recent Findings

In patients with end-stage systolic heart failure (HF) and an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2, orthotopic heart transplantation (OHT) alone is a relative contraindication, with a consensus that these patients are better served with heart-kidney transplant (HKT). However, there is significant variation between institutions regarding timing and indication for heart/kidney transplantation, with little data available to predict post-transplant outcomes. A Scientific Statement from American Heart Association was published detailing the indications, evaluation, and outcomes for Heart-Kidney Transplantation, and noted a steady rise in the incidence of heart/kidney dual organ transplants. Recently, the Organ Procurement and Transplantation Network (OPTN) Multi-Organ Transplantation Committee implemented a safety net policy for heart transplant recipients who do need meet criteria for simultaneous heart-kidney transplant in 2023 but with a likely need for sequential kidney transplantation.

Summary

Optimization of organ distribution and patient outcomes after cardiac transplantation requires appropriate recipient selection. This review also outlines the criteria regarding the evaluation of patients with CKD awaiting heart transplantation and outcomes of combined HKT.

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Abbreviations

HF:

Heart failure

OHT:

Orthotopic heart transplant

HKT:

Heart kidney transplant

CKD:

Chronic kidney disease

eGFR:

Estimated glomerular filtration rate

mGFR:

Measured glomerular filtration rate

AKI:

Acute kidney injury

SRTR:

Scientific Registry of Transplant Recipients

HTN:

Hypertension

DM:

Diabetes mellitus

VA-ECMO:

Veno-arterial extracorporeal membrane oxygenation

CNI:

Calcineurin inhibitor

MDRD:

Modification of Diet in Renal Disease Study Equation

CKD-EPI:

Chronic Kidney Disease Epidemiology Collaboration

UPCR:

Urine protein to creatinine ratio

TA:

Tubular atrophy

IF:

Interstitial fibrosis

ESRD:

End-stage renal disease

LV:

Left ventricle

LKT:

Liver kidney transplant

VAD:

Ventricular assist device

RRT:

Renal replacement therapy

CS:

Cardiogenic shock

MCA:

Mechanical circulatory support

OPTN:

Organ Procurement and Transplant Network

UNOS:

United Network for Organ Sharing

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Author information

Authors and Affiliations

  1. Texas Medical Center, University of Texas/McGoven Medical School, Houston, TX, USA

    Anju Bhardwaj

  2. University of Washington Medical Center, University of Washington School of Medicine, Seattle, WA, USA

    Preethi Pirlamarla

  3. Division of Cardiology, Thomas Jefferson University, Philadelphia, PA, USA

    Yevgeniy Brailovsky

  4. Division of Cardiology, Tufts Medical Center, Boston, MA, USA

    Indranee Rajapreyar

  5. Baylor College of Medicine, Texas Heart Institute, Dallas, TX, USA

    Ajith Nair

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Contributions

AB, IR, and PP wrote the manuscript text and YB prepared all figures. All authors reviewed the manuscript with editing and additions to the manuscript as needed.

Corresponding author

Correspondence to Preethi Pirlamarla.

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Conflict of Interest

Anju Bhardwaj reports Impulse Dynamics—Subject Eligibility Committee for AIMHIGHER trial. Ajith Nair reports speaker honoraria from Janssen Pharmaceutical and Impulse Dynamics. The other authors declare that they have no conflict of interest.

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Bhardwaj, A., Pirlamarla, P., Brailovsky, Y. et al. Combined Heart Kidney Transplantation Versus Heart Transplant in Patients with Renal Failure: Contemporary Insights and Future Perspectives. Curr Cardiol Rep 26, 83–90 (2024). https://doi.org/10.1007/s11886-023-02017-y

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