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Impella 5.5 as Bridge and Mechanical Support Following Simultaneous Heart/Kidney Transplant
Angela Kristo1, Romulo Fajardo2, John Henry Harrison3
1From the The University of Wisconsin School of Medicine (UWSMPH), Madison, WI.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|November 11, 2025
Summary
Preserving Impella 5.5 support during simultaneous heart-kidney transplant (SHKT) facilitated immediate kidney graft function and reduced the need for renal replacement therapy (RRT). This approach may improve outcomes for complex transplant patients.
Area of Science:
- Cardiovascular Surgery
- Transplant Surgery
- Mechanical Circulatory Support
Background:
- Simultaneous heart-kidney transplantation (SHKT) is complex, often involving patients with severe hemodynamic compromise and renal dysfunction.
- Mechanical circulatory support devices, such as the Impella 5.5, are used to stabilize patients awaiting or undergoing cardiac procedures.
- Optimizing outcomes in SHKT requires strategies to minimize delayed graft function and the need for renal replacement therapy (RRT).
Purpose of the Study:
- To evaluate the feasibility and impact of preserving Impella 5.5 mechanical support during SHKT.
- To assess the effect of continued Impella support on immediate kidney graft function and the need for RRT.
- To explore the potential benefits of this strategy in reducing delayed graft function and improving early recovery.
Main Methods:
- A case report of a 60-year-old male patient listed for SHKT.
- Insertion of a right axillary Impella 5.5 due to hemodynamic instability and rising creatinine.
- Performance of a bicaval SHKT with repositioning of the Impella 5.5 across the aortic valve during anastomosis, followed by kidney transplantation in the same operative encounter.
Main Results:
- The patient received Impella 5.5 support throughout the SHKT procedure and postoperatively.
- Immediate urine production was observed, obviating the need for renal replacement therapy (RRT).
- The Impella was removed on postoperative day 4; the patient was discharged on postoperative day 15 with excellent graft function and normalized creatinine.
Conclusions:
- Preserving Impella 5.5 support during SHKT is a viable strategy to facilitate simultaneous kidney transplantation.
- This approach may reduce the risk of delayed kidney graft function and the need for RRT.
- Continued mechanical support can enable early mobilization, reduce vasoactive agent requirements, and potentially improve overall patient recovery.
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