Factors Impacting Early Adverse Outcomes in Simultaneous Heart-Kidney Transplantation

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-01-21 DOI:10.1016/j.transproceed.2024.11.037

Bernard John DuBray , Saed Shawar , Sandip Zalawadiya , Kelly Schlendorf , Bonnie Ann Sarrell , Beatrice P. Concepcion , Scott A. Rega , Irene D. Feurer , David Shaffer , Rachel C. Forbes

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引用次数: 0

Abstract

Background

Over the last decade, the number of simultaneous heart-kidney transplants (SHKTs) has increased dramatically. There are few reports of renal allograft outcomes in these high acuity patients. The goal of the present study was to identify variables that were related to early adverse outcomes (EAOs), including delayed graft function (DGF), primary non-function (PNF), and renal allograft futility (RAF) after SHKTs.

Methods

We performed a single center retrospective review of all adults undergoing SHKTs from October 2011 to August 2021. Multivariable logistic regression models with backward elimination were used to test the relationships between recipient (pre-transplant dialysis, intra-aortic balloon pump, serum lactate, norepinephrine use, and re-do sternotomy) and operative (cold ischemia time [CIT]) variables and the likelihood of DGF, PNF, and RAF.

Results

Sixty-eight patients underwent SHKT during the study period. Overall, patient survival was 87%, 83%, and 80% at 6 months, 1 year, and 3 years, respectively. Twenty-four patients (35%) experienced DGF, whereas 4 patients (6%) had PNF, and 12 patients (18%) had RAF (Table 1). Pre-transplant dialysis, serum lactate, and CIT were significantly associated with an increased likelihood of DGF. Norepinephrine (NE) and CIT were associated with increased likelihood of RAF (Table 2).

Conclusions

Pre-transplant dialysis is related to an increased likelihood of EAO following SHKT, with CIT and NE contributing to increased likelihood of RAF. Given that SHKT recipients are at risk of remaining on dialysis following SHKT, strategies that allow for expedited kidney transplantation after heart transplantation may mitigate the hemodynamic and ischemic constraints of SHKT that contribute to early adverse outcomes.

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影响同期心肾移植早期不良结局的因素。

背景：在过去的十年中，同时进行心脏肾脏移植（SHKTs）的数量急剧增加。在这些高敏度患者中，很少有关于同种异体肾移植结果的报道。本研究的目的是确定与SHKTs后早期不良结局（eao）相关的变量，包括移植功能延迟（DGF）、原发性无功能（PNF）和同种异体肾移植无效（RAF）。方法：我们对2011年10月至2021年8月接受SHKTs的所有成年人进行了单中心回顾性研究。采用后向消除的多变量logistic回归模型检验受者（移植前透析、主动脉内气囊泵、血清乳酸、去甲肾上腺素使用和再次开胸）和手术（冷缺血时间[CIT]）变量与DGF、PNF和RAF可能性的关系。结果：68例患者在研究期间接受了SHKT。总体而言，患者在6个月、1年和3年的生存率分别为87%、83%和80%。24例患者（35%）发生DGF， 4例患者（6%）发生PNF， 12例患者（18%）发生RAF（表1）。移植前透析、血清乳酸和CIT与DGF可能性增加显著相关。去甲肾上腺素（NE）和CIT与RAF的可能性增加有关（表2）。结论：移植前透析与SHKT后EAO的可能性增加有关，CIT和NE有助于增加RAF的可能性。鉴于SHKT受者在SHKT后仍有继续透析的风险，允许心脏移植后加速肾移植的策略可能会减轻SHKT的血流动力学和缺血性限制，这些限制有助于早期不良后果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.