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ECMO During Combined Heart-Kidney Transplantation: A Case Report
Shai M Chazin1, Michael A Bresticker2, Darshika Chhabra3
1From the Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|August 7, 2019
Summary
Combined heart and kidney transplantation (CHKT) is for patients with both heart and kidney failure. This case highlights successful kidney transplantation during venoarterial-ECMO support after heart transplant.
Area of Science:
- Cardiology
- Nephrology
- Transplantation Medicine
Background:
- Combined heart-kidney transplantation (CHKT) addresses end-stage heart and kidney failure.
- Accurate assessment of kidney disease reversibility is vital for patient selection in CHKT.
- Extracorporeal membrane oxygenation (ECMO) is an emerging support modality in CHKT.
Observation:
- A 69-year-old male with cardiogenic shock underwent orthotopic heart transplant (OHT).
- Post-OHT, the patient required venoarterial-ECMO (VA-ECMO) due to mediastinal bleeding.
- The patient successfully underwent a kidney transplant while remaining on VA-ECMO support.
Findings:
- This case demonstrates the feasibility of performing a kidney transplant in a patient supported by VA-ECMO following OHT.
- It is the second reported instance of kidney transplantation during VA-ECMO after OHT.
Implications:
- This case expands the understanding of managing complex cardiac and renal failure patients.
- It suggests that VA-ECMO may not be an absolute contraindication for simultaneous or sequential transplantation.
- Further research is warranted to establish protocols for ECMO-assisted transplantation in CHKT candidates.
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