Original Research
Saturday, October 12, 2024
11:30 AM–01:00 PM
Abstract
Introduction: Recent data suggest worse one-year survival for simultaneous heart-kidney transplant (SHKT) recipients in the new allocation era. Limited reports exist on immunosuppression strategies and outcomes in dual organ heart transplant populations, especially after the 2018 UNOS heart allocation policy change.
Research Question or Hypothesis: How have immunosuppression strategies and outcomes for SHKT recipients evolved since the UNOS allocation policy change?
Study Design: Retrospective cohort study
Methods: This UNOS database analysis included adults (16+ years) who underwent SHKT from August 2013 to December 2022. Immunosuppression regimens and post-transplant outcomes including rejection, infection, graft failure, and all-cause mortality in the first year post-transplant were evaluated.
Results: A total of 2384 patients were included, 708 (29.7%) before and 1676 (70.3%) after the policy change. The extent of decrease in anti-thymocyte globulin induction (46.5% vs 37.1%, p<0.001) was mirrored by the increase in basiliximab use (29.2% vs 38.8%, p<0.001). Compared to before the policy change, at one-year post-transplant, a greater proportion of recipients were on tacrolimus (86.8% vs. 92.1% p=0.002) and an mTOR inhibitor (6.3% vs. 9.7%, p=0.023) while fewer were on mycophenolate (82.6% vs. 78.0% p=0.044). Hospitalization for infection was similar (OR 1.02 95% CI 0.75-1.38). Adjusted odds of hospitalization for rejection were lower in both kidney (OR 0.44, 95% CI 0.26-0.72) and heart allografts (0.52, 95% CI 0.36-0.77). The risk of graft failure was higher after the allocation change for the kidney (HR 1.72, 95% CI 1.17-2.52) with no evidence of a difference for the heart (HR 1.30, 95% CI 0.66-2.64). The one-year survival was comparable (89.7% vs 88.5%, HR 0.79 95% CI 0.52-1.22).
Conclusion: Our analysis did not find a survival difference for SHKT patients after the allocation change. The rates of organ rejection were lower in the post allocation change era despite the less intensive induction therapy.
Presenting Author
Xinyi Huang PharmDLong Island University
Authors
William Baker PharmD, FCCP, FACC, FAHA
University of Connecticut School of Pharmacy
Douglas Jennings PharmD, FACC, FAHA, FCCP, FHFSA
New York Presbyterian Columbia University Medical Center