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[Simultaneous heart and kidney transplantation using the same donor]
J P Cachera1, C Benvenuti, P Deleuze
1Service de Chirurgie thoracique et cardio-vasculaire, Hôpital Henri Mondor, Créteil, France.
Insights
Combined heart and kidney transplants from a single donor are feasible and safe. Post-transplant outcomes show good graft function and no simultaneous rejection episodes, indicating separate monitoring is essential.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Transplantation Medicine
Context:
- End-stage heart and kidney failure necessitate complex treatment strategies.
- Combined organ transplantation offers a potential solution for patients with multi-organ disease.
- Previous therapeutic options were insufficient for the studied patient cohort.
Purpose:
- To evaluate the feasibility and outcomes of combined heart and kidney transplantation from a single donor.
- To assess patient survival, graft function, and rejection episodes post-transplant.
- To determine the necessity of separate monitoring for cardiac and renal rejection.
Summary:
- Five male patients (mean age 58) underwent combined heart and kidney transplantation due to conditions like dilated cardiomyopathy, ischemic heart disease, and polycystic kidney disease.
- No hospital deaths occurred; all patients survived with a mean follow-up of 22 months.
- Patients experienced good renal function recovery and minimal rejection episodes, with no simultaneous cardiac and renal rejection observed.
Impact:
- Combined heart and kidney transplantation is a viable option for carefully selected patients with combined cardiac and renal failure.
- Separate monitoring protocols for cardiac and renal rejection are crucial for effective management.
- Long-term follow-up revealed healthy coronary vessels, suggesting the procedure's durability.
Abstract:
From 1988 to 1991, five cases of combined heart and kidney transplantation using the same donor have been achieved at our institution. All patients were males, 58 +/- 6 (46 to 64). The cardiac condition leading to the cardiac replacement was a dilated cardiomyopathy in one case, end-stage ischemic disease in 3, and failure of a previous cardiac transplantation in one. The renal condition claiming for a graft was a Glomerular nephritis in one, a polycystic disease in 3, and renal failure due to CyA toxicity in one; chronic hemodialysis was mandatory in all patients but one. There were no hospital deaths. The five patients are current survivors, the mean follow-up being 22 +/- 10 months (2-50 months). Five rejection episodes occurred in three patients; two patients have never demonstrated any cardiac rejection. All but one recovered a normal renal function as soon as the 7 th post operative day; only one episode of renal rejection has been detected, easily reversed by corticoids. No simultaneity was ever observed between cardiac and renal rejection episodes. Thus, the detection of rejection must be carried out separately for each graft organ. In four patients, cineangiograms of the coronary vessels were done respectively 12, 30 and 50 months post operatively and revealed a normal coronary bed. Thus, combined heart and kidney transplantation seems to be a realistic approach in properly selected patients in whom cardiac and renal failures cannot be treated by more conventional procedures.