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Combined Heart-Kidney Transplant versus Isolated Heart or Kidney Transplant in Amyloidosis
Abstract   Peer reviewed

Combined Heart-Kidney Transplant versus Isolated Heart or Kidney Transplant in Amyloidosis

S.A. McKay, M. Daniel, J.P. Joshi, D. Telesca, J. Song, H. Zappacosta, P. Cho, J. White, M. Husain, A. Abramov, …
The Journal of heart and lung transplantation, v 45(5), pp 324-325
Apr 2026

Abstract

Purpose: Cardiac amyloidosis can involve multiorgan dysfunction, and combined heart-kidney transplantation (CHKT) offers a therapeutic option for patients with concurrent cardiac and renal failure. This study compared characteristics and perioperative outcomes among isolated heart (HT), isolated kidney (KT), and CHKT recipients. Methods: Adult amyloidosis patients undergoing HT, KT or CHKT were identified in the United Network for Organ Sharing (UNOS) database (1/2000-6/2025). Recipient characteristics were compared across HT only, KT only and CHKT. Secondary outcomes included perioperative complications, graft failure, and in-hospital mortality. Results: A total of 1,782 patients met inclusion criteria: 1,055 (59%) underwent HT, 676 (38%) KT and 51 (3%) underwent CHKT. CHKT recipients were younger than HT and KI recipients, and compared with KT, CHKT and HT patients were more often male and had higher rates of pulmonary hypertension (Table 1). CHKT recipients were more frequently hospitalized at transplant, though HT recipients were more likely to be in the ICU (Table 1). In-hospital mortality was highest after CHKT, compared with HT and KT (Table 2). Rates of early graft failure were lower for CHKT than KT, but higher than HT (Table 2). 72-hour mortality and 30-day mortality were similar across groups (Table 2). Conclusion: In amyloidosis, CHKT recipients had greater pretransplant illness severity and higher perioperative morbidity than isolated KT or HT recipients. CHKT may offer benefit in multiorgan amyloidosis with concurrent cardiac and renal dysfunction, though longer-term evaluation is needed to define survival advantage.

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