Outcomes of Heart Re-Transplantation with Combined Kidney Transplant

Purpose Because the half-life of the transplanted heart is approximately 14 years, re-transplantation may be necessary. Patients requiring redo heart transplant (HTx) may also have developed chronic kidney disease due to calcineurin inhibitor nephrotoxicity or progression of pre-existing renal dysfunction. Therefore, combined kidney transplant may be indicated. We evaluated outcomes following redo HTx with combined kidney transplant. Methods A prospective institutional registry identified 1075 HTx cases between 1/1/2010 and 9/1/2020. Twenty-two patients undergoing redo HTx with kidney transplantation were compared to 55 patients undergoing redo HTx alone. Post-transplant outcomes included 1-year survival, 1-year freedom from cardiac allograft vasculopathy (CAV: stenosis ≥30% by angiography), non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), any treated rejection (ATR), acute cellular rejection (ACR), and antibody-mediated rejection (AMR). Delayed graft function of the transplanted kidney was also evaluated and compared to 16540 patients identified from the national United Network for Organ Sharing database who underwent isolated kidney transplant between 2015 and 2020. Results Patients undergoing redo HTx with combined kidney transplant had higher incidence of post-operative dialysis and longer hospital length of stay. One-year outcomes were similar compared to patients undergoing redo HTx alone (Table). Delayed graft function of the transplanted kidney occurred in 12 patients (54.5%) after redo HTx with combined kidney transplant and 7112 patients (43.0%) after isolated kidney transplant (p=0.274). Conclusion Redo HTx with combined kidney transplant has acceptable one-year outcomes. Significant renal disease in patients requiring redo HTx should not be a contraindication to re-transplantation. Because the half-life of the transplanted heart is approximately 14 years, re-transplantation may be necessary. Patients requiring redo heart transplant (HTx) may also have developed chronic kidney disease due to calcineurin inhibitor nephrotoxicity or progression of pre-existing renal dysfunction. Therefore, combined kidney transplant may be indicated. We evaluated outcomes following redo HTx with combined kidney transplant. A prospective institutional registry identified 1075 HTx cases between 1/1/2010 and 9/1/2020. Twenty-two patients undergoing redo HTx with kidney transplantation were compared to 55 patients undergoing redo HTx alone. Post-transplant outcomes included 1-year survival, 1-year freedom from cardiac allograft vasculopathy (CAV: stenosis ≥30% by angiography), non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), any treated rejection (ATR), acute cellular rejection (ACR), and antibody-mediated rejection (AMR). Delayed graft function of the transplanted kidney was also evaluated and compared to 16540 patients identified from the national United Network for Organ Sharing database who underwent isolated kidney transplant between 2015 and 2020. Patients undergoing redo HTx with combined kidney transplant had higher incidence of post-operative dialysis and longer hospital length of stay. One-year outcomes were similar compared to patients undergoing redo HTx alone (Table). Delayed graft function of the transplanted kidney occurred in 12 patients (54.5%) after redo HTx with combined kidney transplant and 7112 patients (43.0%) after isolated kidney transplant (p=0.274). Redo HTx with combined kidney transplant has acceptable one-year outcomes. Significant renal disease in patients requiring redo HTx should not be a contraindication to re-transplantation.