10-Year Outcomes in Heart-Kidney Transplant Patients: Is There a Protective Effect for the Donor Heart?

Purpose Combined heart-kidney transplantation (HKTx) has been shown to have successful short-term outcomes and possibly protective effects for the donor heart. There are an increasing number of patients (pts) with end-stage heart failure and severe renal failure that require HKTx. We sought to assess the 10-Year outcomes of these pts in our single center. Methods Between 1999 and 2008 we assessed 27 HKTx recipients. A control group that received heart transplant (HTx) alone was included (n=496). Endpoints of this study included renal function (creatinine (Cr) at baseline, 5-years, and 10-years post-transplant), 10-year survival, 10-year freedom from cardiac allograft vasculopathy (CAV, as defined by ≥30% stenosis via angiography), 10-year freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), and 10-year freedom from any-treated rejection. Results There was no significant difference in 10-year survival, freedom from NF-MACE or any-treated rejection between the two groups. Numerically, HKTx had greater 10-year freedom from CAV compared to HTx alone pts but this was not statistically different. HKTx recipients had a significantly increased baseline Cr as expected (see table). Of note, HKTx pts improve Cr immediately due to the renal allograft, but by 10 years post-transplant, renal function begins to decline. Specifically, by 5 and 10 years post-transplant, there was no difference in Cr between HKTx patients and HTx alone pts. The control population also demonstrated a steady increase in Cr long-term due to calcineurin inhibitor immunosuppression. Conclusion HKTx pts have good outcome 10 years after transplant. Renal function tends to decline long-term in both HKTx and HTx alone pts. There may be a protective effect of CAV in HKTx pts however larger numbers are needed to demonstrate these findings.