Perioperative Timing Impacts Renal Graft Outcomes in Simultaneous Heart-Kidney Transplantation

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-09-11 DOI:10.1111/ctr.70312

Brendan P. Lovasik, Neeta Vachharajani, Paighton Miller, Greg Martens, Yiing Lin, Jason Wellen, Jennifer Yu

{"title":"Perioperative Timing Impacts Renal Graft Outcomes in Simultaneous Heart-Kidney Transplantation","authors":"Brendan P. Lovasik, Neeta Vachharajani, Paighton Miller, Greg Martens, Yiing Lin, Jason Wellen, Jennifer Yu","doi":"10.1111/ctr.70312","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Simultaneous heart-kidney (SHK) transplantation is widely administered as a treatment for end-stage cardiorenal disease. However, the impact of renal transplant timing as a concurrent (heart and kidney transplanted simultaneously) or staggered (heart transplant followed by kidney transplant) procedure on post-transplant outcomes has not been investigated.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We conducted a retrospective analysis of the UNOS STAR for SHK transplants that occurred in the United States between 2010 and 2024. Institutional SHK transplant data were similarly reviewed for specific patient-level factors.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Approximately two-thirds (<i>N</i> = 1668) of SHK transplants were performed using the staggered approach, with the remaining one-third performed concurrently (<i>N</i> = 868). Univariate analysis of concurrent versus staggered SHK transplants indicated that staggered SHK transplant was associated with a higher rate of delayed graft function (DGF; 31.4 vs. 25.6%, respectively; <i>p </i>= 0.003) and lower 1-year renal graft survival (89.9 vs. 84.5%, respectively; <i>p </i>< 0.001). A multivariable regression analysis showed that these differences in DGF (HR 1.29, 95% CI 1.05–1.58, <i>p</i> = 0.014) and 1-year graft survival (HR 1.39, 95% CI 1.05–1.83, <i>p</i> = 0.020) remained when other factors were controlled. In multivariable Cox analysis, staggered SHK was associated with lower overall patient survival (HR 0.81, <i>p</i> = 0.045) but no differences in death-adjusted graft survival or need for renal retransplantation (both <i>p</i> > 0.05).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The results from this study indicate that discrepant outcomes in SHK transplantation result from the timing of renal transplantation, with concurrent SHK demonstrating superior outcomes in a large national dataset.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Transplantation","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ctr.70312","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Simultaneous heart-kidney (SHK) transplantation is widely administered as a treatment for end-stage cardiorenal disease. However, the impact of renal transplant timing as a concurrent (heart and kidney transplanted simultaneously) or staggered (heart transplant followed by kidney transplant) procedure on post-transplant outcomes has not been investigated.

Methods

We conducted a retrospective analysis of the UNOS STAR for SHK transplants that occurred in the United States between 2010 and 2024. Institutional SHK transplant data were similarly reviewed for specific patient-level factors.

Results

Approximately two-thirds (N = 1668) of SHK transplants were performed using the staggered approach, with the remaining one-third performed concurrently (N = 868). Univariate analysis of concurrent versus staggered SHK transplants indicated that staggered SHK transplant was associated with a higher rate of delayed graft function (DGF; 31.4 vs. 25.6%, respectively; p = 0.003) and lower 1-year renal graft survival (89.9 vs. 84.5%, respectively; p < 0.001). A multivariable regression analysis showed that these differences in DGF (HR 1.29, 95% CI 1.05–1.58, p = 0.014) and 1-year graft survival (HR 1.39, 95% CI 1.05–1.83, p = 0.020) remained when other factors were controlled. In multivariable Cox analysis, staggered SHK was associated with lower overall patient survival (HR 0.81, p = 0.045) but no differences in death-adjusted graft survival or need for renal retransplantation (both p > 0.05).

Conclusions

The results from this study indicate that discrepant outcomes in SHK transplantation result from the timing of renal transplantation, with concurrent SHK demonstrating superior outcomes in a large national dataset.

查看原文本刊更多论文

心脏-肾脏同步移植围手术期时机影响移植结果。

背景：同时进行心肾移植（SHK）被广泛用于治疗终末期心肾疾病。然而，肾移植时间作为并发（心脏和肾脏同时移植）或交错（心脏移植后肾移植）手术对移植后结果的影响尚未被调查。方法：我们对2010年至2024年在美国发生的SHK移植的UNOS STAR进行了回顾性分析。对机构SHK移植数据进行了类似的审查，以确定特定的患者水平因素。结果：约三分之二（N = 1668）的SHK移植采用交错入路，其余三分之一同时进行（N = 868）。同时移植与交错移植的单因素分析表明，交错移植与更高的移植延迟功能率（DGF；分别为31.4 vs 25.6%; p = 0.003）和较低的1年移植存活率（分别为89.9 vs 84.5%; p 0.05）相关。结论：这项研究的结果表明，SHK移植的不同结果是由肾移植的时间决定的，而在一个大型的国家数据集中，同时进行SHK移植显示出更好的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.