Shinobu Itagaki, MD, MSc Assistant Professor Cardiovascular Surgery Icahn School of Medicine at Mount Sinai, New York, NY

Benefits and Drawbacks of Simultaneous Heart Kidney Transplantation Interview with:

Shinobu Itagaki, MD, MScAssistant Professor Cardiovascular Surgery Icahn School of Medicine at Mount Sinai, New York, NY

Dr. Itagaki

Shinobu Itagaki, MD, MSc
Assistant Professor
Cardiovascular Surgery
Icahn School of Medicine at
Mount Sinai, New York, NY What is the background for this study? Were the transplants from a single donor?

Response: The heart transplantation is the gold standard therapy for end-stage heart failure patients. As the kidney is affected by the heart function, it is common that the heart transplant candidates have some degree of kidney dysfunction as well. In these cases, the candidates are considered for simultaneous heart and kidney transplantation from a same donor. Unlike isolated heart transplantation, where the indication and benefits have been well established, simultaneous heart and kidney transplantation has less clear indication and benefits. This uncertainty is also complicated by the competing interest with isolated kidney transplantation candidates who in general wait longer on the waiting list. What are the main findings?

Response:  Using a national registry date, we selected the heart transplant recipients who had some baseline kidney dysfunction before transplantation. This is the patient cohort who could potentially benefit from the simultaneous heart kidney transplantation rather than isolated heart transplantation. We stratified this patient cohort depending on the degree of baseline kidney dysfunction and compared post-transplant survival by the transplantation type, either heart alone versus simultaneous heart kidney transplantation. We found that the simultaneous heart and kidney transplantation provided better survival for the recipients who were on dialysis and also non-dialysis dependent yet moderate kidney dysfunction [up to GFR (glomerular filtration rate) around 40ml/min]. The findings we described above is actually not so entirely new but we added some new aspect on this study. A donor who donated the heart and kidney to one recipient (who is the simultaneous heart kidney recipient) generally donated the other kidney to another recipient (who is always isolated kidney transplantation recipient) so we also tracked the longevity of these 2 kidneys depending on which destinations these kidney reached. We found the implanted kidney had almost twice risk of losing its function when implanted as simultaneous heart kidney transplantation compared to isolated kidney transplantation. What should readers take away from your report?

Response: The key take-away message is that the simultaneous heart kidney transplantation does help patients who have heart and kidney dysfunction but as the cost of significantly increased risk of losing the implanted kidney compared to if the kidney was transplanted in isolation. It is the complex issue as we as a clinician focus on the patients in front of you but we need to be cognizant of the concept of the societal utility and benefit under the limited supply of valuable organs. What recommendations do you have for future research as a results of this study?

Response: We need more studies to predict in which cases the native kidney may recover just by isolated heart transplantation and also to predict in which cases the transplanted kidney has high risk of losing its function. These studies would give us some guidance to avoid too preemptive or too futile simultaneous kidney transplantation use.

Thank you for the opportunity for the interview and hope this study helps future research.


Outcomes of Simultaneous Heart and Kidney Transplantation
Shinobu Itagaki, Nana Toyoda, Noah Moss, et al. 
VOL. 81, NO. 8, 2023 ª 2023

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Last Updated on February 21, 2023 by Marie Benz