title: Simultaneous heart and kidney transplantation as treatment for end-stage heart and kidney failure.
abstract: 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.
authors.affiliation: Department of Surgery, University of Vienna, Vienna General Hospital, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Laufer
authors.forename: A
authors.initials: A
authors.lastname: Kocher
authors.forename: M
authors.initials: M
authors.lastname: Grabenwöger
authors.forename: G A
authors.initials: GA
authors.lastname: Berlakovich
authors.forename: A
authors.initials: A
authors.lastname: Zuckermann
authors.forename: P
authors.initials: P
authors.lastname: Ofner
authors.forename: M
authors.initials: M
authors.lastname: Grimm
authors.forename: R
authors.initials: R
authors.lastname: Steininger
authors.forename: F
authors.initials: F
authors.lastname: Mühlbacher
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival / Q000502:physiology; D015234:HLA-A Antigens / Q000032:analysis; D015235:HLA-B Antigens / Q000032:analysis; D006684:HLA-DR Antigens / Q000032:analysis; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation / Q000276:immunology / Q000502:physiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology; D008297:Male; D008875:Middle Aged
chemical_list: D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006684:HLA-DR Antigens