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Anesthetic and Perioperative Considerations for Combined Heart-Kidney Transplantation
Santiago Mc Loughlin1, Juan C Bianco1, Ricardo G Marenchino2
1Department of Anesthesiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Insights
Combined heart and kidney transplant (HKT) patients face significant perioperative risks. Lower cardiac index and central venous pressure were associated with higher mortality in HKT recipients.
Area of Science:
- Cardiology
- Nephrology
- Transplant Surgery
Background:
- Combined heart and kidney transplantation (HKT) is a complex procedure for patients with end-stage heart and kidney failure.
- Understanding the perioperative challenges is crucial for improving patient outcomes.
Purpose of the Study:
- To detail the perioperative characteristics of combined heart and kidney transplant (HKT) recipients.
- To identify factors associated with mortality in the perioperative period.
Main Methods:
- Retrospective analysis of consecutive adult HKT recipients (January 2013 - July 2016).
- Analysis of demographic, hemodynamic, and perioperative data.
- Actuarial survival rates and factors associated with in-hospital mortality were assessed.
Main Results:
- Actuarial survival rates were 57% in-hospital and 43% at mean follow-up.
- Patients requiring postoperative hemodialysis had a 75% in-hospital mortality rate.
- Lower postoperative cardiac index and central venous pressure were linked to increased mortality.
- Early postoperative hemodynamics showed decreased systemic vascular resistance and increased cardiac output.
Conclusions:
- Anesthesiologists play a vital role in managing HKT patients due to their complex comorbidities.
- Perioperative strategies should leverage anesthesiology expertise for optimal HKT outcomes.
Objective:
To describe detailed perioperative features of combined heart and kidney transplant (HKT).
Design:
Retrospective study.
Setting:
Tertiary care university hospital.
Participants:
All consecutive HKT recipients aged 18 years and older.
Interventions:
None.
Measurements And Main Results:
After approval of the Institutional Review Board, the authors studied all consecutive adult patients who underwent HKT between January 2013 and July 2016. Recipient and donor's demographic data, hemodynamic profile, and perioperative data were analyzed. Actuarial survival rate was 57% and 43% for in-hospital and after a mean follow-up of 135 (266) days, respectively. Among patients who required postoperative hemodialysis (n = 4), 75% (n = 3) died during hospital stay. In unadjusted analysis, patients who died had a lower postoperative cardiac index (5.4 [2.7] v 3.2 [1] L/min/m2; p = 0.034) and central venous pressure (11 [5] v 8.5 [3] mmHg; p = 0.032). All patients underwent a nonstaged surgery. When compared with preoperative hemodynamic variables, early postoperative values showed decreased systemic vascular resistance (1,333 [433] dyn/s/cm-5v 595 [176] dyn/s/cm-5; p = 0.028) and higher cardiac output (4.3 [1.4] L/min v 6.7 [3] L/min; p = 0.018). Median hospital stay was 63 (44) days.
Conclusions:
Anesthesiologists should be actively involved in perioperative strategies on how to manage these critical patients with severe cardiac and noncardiac comorbidities applying their expertise to HKT procedure.
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