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Patients with severe heart failure who have undergone placement of a mechanical circulatory support (MCS) device do develop renal dysfunction. This renal dysfunction is not severe enough to necessitate the use of combined heart transplantation (HTx) and kidney transplantation. However, it has not been firmly established whether kidney dysfunction does add to increased morbidity or mortality after HTx in these device patients. Between 2012 and 2019, we assessed 79 patients who have undergone MCS, either with total artificial heart (n=22) or left ventricular assist device (n=53). Baseline creatinine/glomerular filtration rate (GFR) was measured and patients were divided into GFR categories which include 30-39 mL/min, 40-49 mL/min, 50-59 mL/min, and greater than or equal to 60 mL/min. All patients underwent HTx alone. The need for temporary dialysis was recorded, as well as peak creatinine in the first 3 months after HTx and serum creatinine at 1 year compared to baseline. Further outcomes include subsequent 1-year survival, freedom from cardiac allograft vasculopathy (CAV, stenosis ≥30%), and freedom from non-fatal major adverse cardiac event (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke). There was no significant difference in 1-year survival, CAV, and NF-MACE or the need for temporary dialysis amongst all groups. Furthermore, no patient in any group needed chronic dialysis. In the GFR 40-49 group compared to the other groups, there was a trend for higher creatinine at 1 year but the baseline was high. Baseline lower GFRs between 30-39 and 40-49 mL/min in MCS patients do not appear to be a predictor of poorer outcomes after HTx in patients. These patients do not appear to require combined heart and kidney transplantation. [ABSTRACT FROM AUTHOR]

Heart-kidney transplant (HKTx) patients have acceptable outcomes post-transplant. Patients on mechanical circulatory support (MCS) devices who undergo heart transplantation have the potential of several complications such as longer cold ischemic time due the time relegated to explant these devices due to extensive scar tissue and bleeding. In addition, many of these patients receive a significant number of blood products for bleeding episodes which can cause right ventricular dysfunction of the donor heart. Time in the intensive care unit (ICU) is also potentially increased due to the various complications that may occur. This would also include takebacks to the operating room (OR) for extensive bleeding. We reviewed our database to illuminate differences in patients with and without MCS undergoing HKTx. Between 2017 and 2019, we assessed 43 patients undergoing HKTx and divided them into MCS (n=7) versus non-MCS patients (n=36). Endpoints included cold ischemic time, time in the ICU, number of blood products administered, takebacks to the OR for bleeding, 30-day survival, 1-year survival, 1-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), 1-year freedom from cardiac allograft vasculopathy (CAV, stenosis ≥30% by angiography), and the development of severe primary graft dysfunction (PGD). Heart-kidney transplant patients with MCS versus those without MCS had significantly greater packed red blood cells needed and prolonged ICU length of stay. There were no differences between the 2 groups in 1-year survival, freedom from CAV, NF-MACE, and PGD. Heart-kidney transplant candidates on MCS do not appear to have worse 1-year outcomes. Excess bleeding and prolonged ICU stay are the only adverse complications noted. These patients on MCS should be considered for HKTx. [ABSTRACT FROM AUTHOR]