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Combined heart and kidney transplantation: long-term analysis of renal function and major adverse events at 20 years
G Bruschi1, L Botta, T Colombo
1Cardiology & Cardiac Surgery Department A De Gasperis, Niguarda Ca' Granda Hospital, Milan, Italy. giuseppe.bruschi@fastwebnet.it
Insights
Combined heart-kidney transplantation (HKTx) offers good long-term outcomes for patients with end-stage heart and kidney failure. This procedure demonstrates satisfactory results with few complications in selected candidates.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Combined heart-kidney transplantation (HKTx) is a viable treatment for patients with end-stage heart disease and severe kidney dysfunction.
- This study reports on the long-term follow-up of patients undergoing this combined procedure.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of combined heart-kidney transplantation (HKTx).
- To assess patient survival and allograft outcomes following HKTx.
Main Methods:
- A retrospective analysis of nine patients who underwent simultaneous HKTx between April 1989 and November 2009.
- Patient demographics, perioperative course, and long-term outcomes including survival and graft function were reviewed.
Main Results:
- The majority of patients (7/9) were male, with seven requiring dialysis pre-transplant.
- One patient died early (41 days post-transplant); three late deaths occurred due to infection, neoplasm, and stroke.
- Only one patient experienced renal allograft failure at 10 years; others maintained good estimated glomerular filtration rates (eGFR).
Conclusions:
- Combined HKTx is a successful strategy for selected patients with combined cardiac and renal end-stage failure.
- The procedure yields satisfactory short- and long-term results with a low complication rate for both cardiac and renal allografts.
Background:
Combined heart-kidney transplantation (HKTx) is an accepted therapeutic option for patients with end-stage heart disease associated with severely impaired renal function. We report our long-term follow-up with this combined procedure.
Patients And Methods:
Between April 1989 to November 2009, nine patients underwent combined simultaneous (HKTx) at our center. Seven patients were males (mean age 45.2 +/- 10.12 years); seven patients were on dialysis at the time of transplantation.
Results:
Surgical procedures were uneventful in all patients. One patient died in the intensive care unit 41 days after transplantation. During long-term follow-up, three patients died: one due to infection and multiorgan failure 148 months after HKTx, one due to a lung neoplasm after 6 years, and one, a cerebral stroke at 34 months after transplantation. Only one patient experience renal allograft failure secondary to hypertension and cyclosporine nephrotoxicity at 10 years after HKTx with the need for renal replacement therapy. Last estimated glomerular filtration rates of all other patients was 61.3 +/- 17.4 mL/min.
Conclusions:
In selected patients, with coexisting end-stage cardiac and renal failure, combined HKTx with an allograft from the same donor proved to give satisfactory short- and long-term results, with a low incidence of both cardiac and renal allograft complications.
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