Long-term follow-up of simultaneous heart and kidney transplantation with single donor allografts: report of nine cases.
BACKGROUND
Combined heart-kidney transplantation is an accepted therapeutic option for patients with end-stage heart disease associated with severely impaired renal function. We report our single-institutional experience with this combined procedure and long-term follow-up.


METHODS
Between April 1989 and August 2006, 9 patients underwent combined simultaneous heart-kidney transplantation at our center. Seven patients were male (mean age, 45.2 +/- 10.12 years); 7 patients were on dialysis at transplantation. Whenever possible, donors were selected on the basis of ABO identity, weight (ratio > or = 0.9), on-site or short-distance procurement, young age, low inotropic support, and normal renal function.


RESULTS
Mean ischemic time was 132.2 +/- 57.0 minutes for the cardiac allograft and 6.0 +/- 1.0 hours for the kidney. Surgical procedure was uneventful in all patients. One patient died in the intensive care unit 41 days after transplantation. Three patients died during follow-up, 1 of lung neoplasm after 6 years, 1 of cerebral stroke after 34 months, and 1 of infection and multiorgan failure after 148 months. The mortality rates led to an overall actuarial survival of 88.9% +/- 10.4% at 1 year, 77.8% +/- 13.6% at 5 years, and 64.8% +/- 16.5% at 10 years. Seven patients lived beyond 5 years, 4 beyond 10 years, and the patient who has longest survival is patient no. 1, with 17 years of follow-up. One patient lost kidney function after 113 months.


CONCLUSIONS
In selected patients, with coexisting end-stage cardiac and renal failure, combined heart-kidney transplantation with allograft from the same donor proved to have satisfactory short- and long-term results, with a low incidence of both cardiac and renal allograft rejection.
Bruschi
Giuseppe
G
Department of Cardiology and Cardiac Surgery A. De Gasperis, Niguarda Ca' Granda Hospital, Milan, Italy. giuseppe.bruschi@fastwebnet.it
Busnach
Ghil
G
Colombo
Tiziano
T
Radaelli
Loredana
L
Pedrazzini
Giovanna
G
Garatti
Andrea
A
Sansalone
Cosimo V
CV
Frigerio
Maria
M
Vitali
Ettore
E
D000328:Adult; D009202:Cardiomyopathies / Q000145:classification / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000502:physiology*; D006801:Humans; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome