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Combined heart-kidney transplantation with single-donor allografts
C Blanche1, A Kamlot, D A Blanche
1Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif 90048, USA. Carlos.Blanche@cshs.org
Insights
Combined heart-kidney transplants offer comparable long-term survival to heart-only transplants for patients with severe heart and kidney disease. This dual transplantation approach shows promising results with low rejection rates.
Area of Science:
- Cardiology
- Nephrology
- Transplantation Immunology
Background:
- Combined heart-kidney transplantation is a viable option for patients with end-stage heart and kidney failure.
- This procedure utilizes allografts from a single donor for both organs.
Purpose of the Study:
- To analyze the long-term outcomes of combined heart-kidney transplantation.
- To compare these results with heart-only transplantation over a 7-year period.
Main Methods:
- A retrospective analysis of 10 patients undergoing combined heart-kidney transplantation between 1992 and 1999.
- Patient characteristics included advanced cardiomyopathy (mean LVEF 19.4%) and renal disease (mean creatinine clearance 25.4 mL/min).
Main Results:
- No operative mortality was observed in the combined transplant group.
- Actuarial survival at 5 years was 55% +/- 20.1% for combined transplants versus 71% +/- 3.9% for heart-only transplants (P =.37).
- Renal allograft survival was 90% at 1 and 2 years, with low rates of cardiac allograft rejection.
Conclusions:
- Combined heart-kidney transplantation provides satisfactory long-term results comparable to heart-only transplantation.
- This approach expands eligibility for patients with combined end-stage cardiac and renal disease.
- The use of single-donor allografts is associated with good renal allograft survival and low cardiac rejection rates.
Objectives:
Combined heart-kidney transplantation with allografts from the same donor has been long proved to be a feasible approach for selected patients with coexisting end-stage cardiomyopathy and renal disease. The purpose of this retrospective study is to analyze our long-term results and compare these results with heart-only transplantation over a 7-year period.
Methods:
Between June 1992 and April 1999, 10 patients underwent combined heart-kidney transplantation at Cedars-Sinai Medical Center. They were all men from 44 to 70 years old (mean age, 59 +/- 8.3 years) who had a mean left ventricular ejection fraction of 19.4% +/- 5.0% (range, 9%-25%) and a mean creatinine clearance of 25.4 mL/min (range, 10-39 mL/min). Four patients underwent pretransplantation dialysis.
Results:
There was no operative mortality. The actuarial survival at 1, 2, and 5 years was 100%, 88% +/- 11.7%, and 55% +/- 20.1%, respectively. By comparison, the operative mortality of 169 patients who underwent heart-only transplantation during the same time interval was 2.4%, with an actuarial survival at 1, 2, and 5 years of 92% +/- 2.1%, 84% +/- 2.8%, and 71% +/- 3.9%, respectively (P =.37). Eight patients showed no evidence of significant (> or =1B) cardiac allograft rejection postoperatively, and the actuarial freedom from rejection at 30 days, 1 year, and 2 years was 90% +/- 9%, 80% +/- 13%, and 80% +/- 13%, respectively. Renal allograft survival was 90% at 1 and 2 years.
Conclusions:
Combined heart-kidney transplantation yields satisfactory long-term results similar to those for heart-only transplantation, with a low incidence of cardiac allograft rejection and renal allograft survival when both allografts are from the same donor. This approach effectively expands the selection criteria for heart-only and kidney-only transplantation in potential candidates with coexisting end-stage cardiac and renal disease.
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