Renal graft outcome in simultaneous kidney transplantation combined with other organs: experience of a single center.
OBJECTIVE
We report the renal graft outcomes among a series of patients who underwent simultaneous combined liver-kidney transplantations (CLKT) or heart-kidney transplantations (CHKT) at a single center.


METHODS
From 1975 to December 31, 2007, we performed 1524 kidney transplantations, 427 liver transplantations, and 483 heart transplantations, including 7 simultaneous CLKT and 2 CHKT. We analysed the main patient characteristics, renal graft outcomes, and patient survivals.


RESULTS
CLKT indications were as follows: alcoholic cirrhosis (n = 5) and hepatitis C virus (n = 2) with chronic glomerulonephritis (n = 5), hypertensive nephropathy (n = 1), and polycystic disease (n = 1). Cold renal ischemia time was 6.9 hours (range, 6-9). In 5 patients there were no kidney rejection episodes; 3 of these patients are alive with creatinine levels between 1.4 and 1.7 mg/dL with an average follow-up of 6.9 years (range, 10 months-8 years). One patient died of esophageal cancer at 13 years after transplantation with a serum creatinine level of 1.16 mg/dL and another died of breast cancer at 7 years after transplantation with a creatinine level of 1.1 mg/dL. One patient lost his renal graft just after the kidney transplantation due to renal vein thrombosis. The last patient suffered 1 episode of acute rejection and lost his kidney 5 years later due to chronic rejection. CHKT indications were as follow: dilated myocardiopathy (n = 2) and chronic glomerulonephritis (n = 1) or interstitial nephropathy (n = 1). The cold renal ischemia time was 4 hours. There were no acute rejection episodes. One patient is alive with a creatinine level of 2.05 mg/dL at 6 years after the transplantation; the other patient lost his kidney due to chronic rejection at 270 days after simultaneous CHKT, and 2 years later received a second kidney that is functioning normally.


CONCLUSIONS
Simultaneous CLKT and CHKT in selected cases provided satisfactory long-term outcomes in both graft function and patient survival with lesser number of acute rejection episodes than nonsimultaneous transplantations. They are worthy options for patients with liver or heart failure associated with renal failure.
Gutierrez-Baños
J
J
Department of Urology, University Hospital Valdecilla, Santander, Spain. jlgb@ono.com
Portillo
J
J
Ballestero
R
R
Zubillaga
S
S
Ramos
E
E
Campos
J
J
Hidalgo
E
E
D000328:Adult; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000150:complications / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality / Q000502:physiology*; D006526:Hepatitis C / Q000150:complications / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000601:surgery; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology*; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis
D007166:Immunosuppressive Agents; D003404:Creatinine