Combined heart-kidney transplantation with single-donor allografts.
OBJECTIVE
Combined heart-kidney transplantation with allografts from the same donor has been long proved to be a feasible approach for selected patients with coexisting end-stage cardiomyopathy and renal disease. The purpose of this retrospective study is to analyze our long-term results and compare these results with heart-only transplantation over a 7-year period.


METHODS
Between June 1992 and April 1999, 10 patients underwent combined heart-kidney transplantation at Cedars-Sinai Medical Center. They were all men from 44 to 70 years old (mean age, 59 +/- 8.3 years) who had a mean left ventricular ejection fraction of 19.4% +/- 5.0% (range, 9%-25%) and a mean creatinine clearance of 25.4 mL/min (range, 10-39 mL/min). Four patients underwent pretransplantation dialysis.


RESULTS
There was no operative mortality. The actuarial survival at 1, 2, and 5 years was 100%, 88% +/- 11.7%, and 55% +/- 20.1%, respectively. By comparison, the operative mortality of 169 patients who underwent heart-only transplantation during the same time interval was 2.4%, with an actuarial survival at 1, 2, and 5 years of 92% +/- 2.1%, 84% +/- 2.8%, and 71% +/- 3.9%, respectively (P =.37). Eight patients showed no evidence of significant (> or =1B) cardiac allograft rejection postoperatively, and the actuarial freedom from rejection at 30 days, 1 year, and 2 years was 90% +/- 9%, 80% +/- 13%, and 80% +/- 13%, respectively. Renal allograft survival was 90% at 1 and 2 years.


CONCLUSIONS
Combined heart-kidney transplantation yields satisfactory long-term results similar to those for heart-only transplantation, with a low incidence of cardiac allograft rejection and renal allograft survival when both allografts are from the same donor. This approach effectively expands the selection criteria for heart-only and kidney-only transplantation in potential candidates with coexisting end-stage cardiac and renal disease.
Blanche
C
C
Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif 90048, USA. Carlos.Blanche@cshs.org
Kamlot
A
A
Blanche
D A
DA
Kearney
B
B
Wong
A V
AV
Czer
L S
LS
Trento
A
A
D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D003404:Creatinine / Q000378:metabolism; D006084:Graft Rejection; D006085:Graft Survival; D006331:Heart Diseases / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000378:metabolism / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014850:Waiting Lists
D003404:Creatinine