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Simultaneous heart and kidney transplantation as treatment for end-stage heart and kidney failure
G Laufer1, A Kocher, M Grabenwöger
1Department of Surgery, University of Vienna, Vienna General Hospital, Austria.
Insights
Simultaneous heart and kidney transplantation (HNTX) shows 100% survival. This approach offers shorter kidney ischemic times and no observed kidney rejection, justifying its use for suitable patients.
Area of Science:
- Nephrology
- Cardiology
- Transplant Surgery
Background:
- Simultaneous heart and kidney transplantation (HNTX) is infrequently reported but increasingly necessary due to expanded criteria for heart transplant (HTX) and kidney transplant (NTX).
- This study evaluates the clinical strategy and outcomes of HNTX using organs from the same donor.
Purpose of the Study:
- To define the role of simultaneous heart and kidney transplantation (HNTX).
- To compare HNTX outcomes with separate heart transplant (HTX) and kidney transplant (NTX) procedures.
Main Methods:
- Analysis of six HNTX recipients (1990-1996), including those with type I diabetes.
- Comparison with 379 HTX and 769 NTX recipients during the same period.
- Evaluation of clinical and immunological demographics and outcomes.
Main Results:
- 100% survival rate for HNTX patients with a mean follow-up of 32.7 months.
- Significantly shorter cold ischemic time for kidneys in HNTX compared to NTX (6.5 hr vs. 22.1 hr).
- No observed kidney rejection in HNTX recipients despite HLA-unmatched grafts; heart rejection rates were similar to HTX.
Conclusions:
- Simultaneous heart and kidney transplantation yields satisfying results, supporting the use of two organs for one recipient.
- Favorable kidney outcomes in HNTX are likely due to increased immunosuppression and short cold ischemic times.
- The effectiveness of HNTX justifies its consideration in select patient populations.
Background:
The aim of the present analysis was to define the role of simultaneous heart and kidney transplantation (HNTX) using organs from the same donor by evaluation of clinical strategy and achieved outcome compared with a reference group of concurrently single heart transplant (HTX) and kidney transplant (NTX) recipients. Compared with other organ combinations (pancreas-kidney, heart-lung), HNTX has been performed infrequently and is reported mainly as case records in the literature. Because of expansion of recipient selection criteria for HTX and NTX, the number of patients requiring simultaneous replacement of both organs is increasing.
Methods:
Six HNTX recipients, three of them suffering from long-standing type I diabetes, received transplants between September 1990 and March 1996 and were analyzed in terms of clinical and immunological demographics and outcome. They were compared with 379 HTX and 769 NTX recipients operated upon within this period.
Results:
Survival for HNTX is 100% with a mean follow-up of 32.7+/-21.1 months. Cold ischemic time of the kidney was significantly shorter for HNTX than for NTX (6.5+/-1.0 hr vs. 22.1+/-6.8 hr, P<0.005). Although HNTX patients received HLA-unmatched grafts, no rejection of the kidney has been observed to date. There was no difference for rejection of the heart in HNTX compared to HTX recipients.
Conclusions:
Satisfying results are obtained by HNTX and justify the use of two organs for one recipient. The favorable immunological behavior of the kidney despite use of HLA-unmatched grafts is most probably explained by higher immunosuppression and short cold ischemic time, although a combination effect cannot be excluded.