Improved waitlist and comparable post-transplant outcomes in simultaneous heart-kidney transplantation under the 2018 heart allocation system.

Autor:	Hong Y; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa., Hess NR; Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa., Ziegler LA; Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa., Hickey GW; Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa., Huston JH; Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa., Mathier MA; Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa., McNamara DM; Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa., Keebler ME; Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa., Gómez H; Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa., Kaczorowski DJ; Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa. Electronic address: kaczorowskidj2@upmc.edu.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2024 Mar; Vol. 167 (3), pp. 1064-1076.e2. Date of Electronic Publication: 2023 Jul 21.
DOI:	10.1016/j.jtcvs.2023.07.012
Abstrakt:	Objective: This study aimed to investigate the clinical trends and the impact of the 2018 heart allocation policy change on both waitlist and post-transplant outcomes in simultaneous heart-kidney transplantation in the United States. Methods: The United Network for Organ Sharing registry was queried to compare adult patients before and after the allocation policy change. This study included 2 separate analyses evaluating the waitlist and post-transplant outcomes. Multivariable analyses were performed to determine the 2018 allocation system's risk-adjusted hazards for 1-year waitlist and post-transplant mortality. Results: The initial analysis investigating the waitlist outcomes included 1779 patients listed for simultaneous heart-kidney transplantation. Of these, 1075 patients (60.4%) were listed after the 2018 allocation policy change. After the policy change, the waitlist outcomes significantly improved with a shorter waitlist time, lower likelihood of de-listing, and higher likelihood of transplantation. In the subsequent analysis investigating the post-transplant outcomes, 1130 simultaneous heart-kidney transplant recipients were included, where 738 patients (65.3%) underwent simultaneous heart-kidney transplantation after the policy change. The 90-day, 6-month, and 1-year post-transplant survival and complication rates were comparable before and after the policy change. Multivariable analyses demonstrated that the 2018 allocation system positively impacted risk-adjusted 1-year waitlist mortality (sub-hazard ratio, 0.66, 95% CI, 0.51-0.85, P < .001), but it did not significantly impact risk-adjusted 1-year post-transplant mortality (hazard ratio, 1.03; 95% CI, 0.72-1.47, P = .876). Conclusions: This study demonstrates increased rates of simultaneous heart-kidney transplantation with a shorter waitlist time after the 2018 allocation policy change. Furthermore, there were improved waitlist outcomes and comparable early post-transplant survival after simultaneous heart-kidney transplantation under the 2018 allocation system. (Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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