Background Simultaneous heart–kidney transplantation (SHKT) or isolated heart transplantation (IHT) benefits patients with end‐stage heart disease and kidney dysfunction. Understanding the outcomes, risk factors for post‐IHT kidney transplantation, and survival benefits of SHKT compared with those of IHT and kidney‐after‐heart transplantation can guide clinical decision‐making. This study aimed to evaluate IHT outcomes, identify risk factors for post‐IHT isolated kidney transplantation, and compare the survival benefits of IHT, SHKT, and kidney‐after‐heart transplantation. Methods This retrospective study analyzed data from the United Network for Organ Sharing database, spanning 2000 to 2022. Adult patients (aged ≥18 years) who underwent their first IHT (n=48 069) or SHKT (n=2345) were included. Among patients undergoing IHT, 667 (1.4%) subsequently received isolated kidney transplantation. The primary outcome was patient survival, which was visualized by Kaplan–Meier analysis and assessed using the shared‐frailty Cox proportional hazards model. Survival rates were compared among IHT, SHKT, and kidney‐after‐heart transplantation recipients. Logistic regression analysis identified risk factors for post‐IHT isolated kidney transplantation. Results The recipient's age, body mass index, pre‐IHT diabetes, prior dialysis, and estimated glomerular filtration rate were significant risk factors for post‐IHT isolated kidney transplantation. Kaplan–Meier analysis showed significantly higher survival with SHKT than with IHT (1‐year: 88.0% versus 85.7%; 5‐year: 70.5% versus 64.1%; 10‐year: 38.1% versus 30.3%; overall P =0.005). Compared with kidney‐after‐heart transplantation, SHKT tended to show lower short‐term survival but higher long‐term survival (5‐year: 72.1% versus 61.9%, P =0.047; 10‐year: 42.9% versus 15.8%, P <0.001). Conclusions Selected patients with end‐stage heart disease and kidney dysfunction derive more long‐term survival benefit from SHKT than from IHT.
Yajima et al. (2026) studied this question.