Contemporary Immunosuppression Management and 1-Year Outcomes in Dual Organ Heart Transplantation

Background

There have been limited reports on immunosuppression strategies and outcomes in dual organ heart transplant populations, primarily from before the 2018 United Network for Organ Sharing (UNOS) heart allocation policy change. Recent data suggested that outcomes with heart–lung and heart–liver transplants remained comparable in the new allocation era, yet heart–kidney recipients have worse 1-year survival.

Methods

This single-center retrospective study evaluated adult heart–kidney, heart–liver, and heart–lung transplant recipients from September 2019 to May 2023. Immunosuppression regimen, infectious complications, and graft outcomes were collected for 12 months.

Results

A total of 36 patients (kidney n = 20, liver n = 9, and lung n = 7) were included in this study. Basiliximab was the most commonly employed induction strategy across the organ groups (12/20 in kidney, 4/9 in liver, and 7/7 in lung). All patients were on triple immunosuppression at 12 months posttransplant with prednisone wean achieved in one heart–liver recipient. Infection complications were frequently reported (95% kidney, 75% liver, 100% lung group). One patient went back to dialysis due to focal segmental glomerulosclerosis. One chronic lung allograft dysfunction was reported, but no other severe biopsy-proven rejection or retransplant was reported. The 1-year survival was 85% (17/20) in heart–kidney, 78% (7/9) in heart–liver, and 86% (6/7) in heart–lung recipients.

Conclusion

This study summarized real-world immunosuppression strategies and outcomes in dual organ heart transplant recipients.