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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
PubMed

Insights

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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