Successful Combined Heart-Kidney Transplants Using Donors with Acute Kidney Injury: 15 Year Single-Institution Experience

Purpose In patients with NYHA Class IV heart failure, renal disease may limit candidacy for heart transplantation. Combined heart-kidney transplantation has been effective in patients with multi-organ failure, thereby improving long-term cardiac graft function and overall patient survival. Donors with acute kidney injury (AKI) may limit available organs for transplantation. We aimed to report our experience using donor kidneys with AKI in combined heart-kidney transplantation. Methods From 2005-2020, a single institutional retrospective chart review of patients undergoing combined heart-kidney transplants was performed. The United Network for Organ Sharing (UNOS) database was used to collect data. Statistical analysis was done using a two-sample T-test and comparison of means test. Results were stratified by age, sex, post-operative length of stay (LOS), episodes of rejection, post-operative CRRT, post-operative delay in renal graft function, and cardiac function. Results 35 patients received combined heart-kidney transplants. Average age was 59.37 years. Average follow-up was 50.58 months. In our patient pool, 77.2% were male and 22.8% were female. 5 patients received kidneys from donors who had AKI, of which 1 had delayed graft function (20%). 14 patients who received donor kidneys without AKI had delayed graft function (43.3%) (p=0.88). Average LOS was not statistically different. Current eGFR was not statistically different. 3 patient deaths were not related to graft rejection. See Table 1. Conclusion This study demonstrates that combined heart-kidney transplantation can be done safely and effectively using donor kidneys with AKI. Our analysis shows no difference in post-operative delayed graft function of the kidney with AKI, LOS, and renal/cardiac function. Although our experience suggests safe use of donor kidneys with AKI, larger studies are necessary to define the short and long-term outcomes of combined heart-kidney transplantation with AKI donors.