Long-term results of combined heart and kidney transplantation: a French multicenter study.
BACKGROUND
Outcomes in recipients who have undergone combined heart and kidney transplantation have mainly been addressed in small, single-center studies. We studied long-term results of combined heart and kidney transplantation in a large multicenter cohort.


METHODS
Between 1984 and 2007, 67 consecutive patients (61 men and 6 women) from 3 French centers underwent combined heart and kidney transplantation. At transplantation, 38 (57%) were receiving dialysis. All patients received immediate triple immunosuppression therapy (anti-calcineurin, steroids, azathioprine, or mycophenolate).


RESULTS
Overall actuarial survival rates were 62.0%, 60.3%, 53.3%, and 46.5% at 1, 3, 5, and 10 years, respectively. These rates were similar to those observed in 2981 isolated heart recipients at the 3 participating centers during the same period (respectively, 71.0%, 65.2%, 60.1%, and 47.2%, p = 0.6). Survival tended to improve during the last decade (1996 to 2007) and reached 71.1%, 67.5%, and 60% at 1, 3, and 5 years. Cardiac allograft rejection requiring treatment occurred in 12 (17.9%). Coronary artery vasculopathy developed in 3 (9.3%). Kidney allograft rejection occurred in 9 (13.4%). Kidney graft survival was 95.9% at 1, 3, 5, and 10 years.


CONCLUSIONS
Long-term survival rates in a large cohort of combined heart and kidney recipients are similar to those of isolated heart recipients in France. The rates of acute heart and kidney rejection and angiographic coronary artery vasculopathy were low in this patient population.
Vermes
Emmanuelle
E
Department of Cardiac Surgery, Henri-Mondor University Hospital, Créteil, France.
Grimbert
Philippe
P
Sebbag
Laurent
L
Barrou
Benoit
B
Pouteil-Noble
Claire
C
Pavie
Alain
A
Obadia
Jean François
JF
Loisance
Daniel
D
Lang
Philippe
P
Kirsch
Matthias
M
D000206:Actuarial Analysis; D000328:Adult; D002423:Cause of Death; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000276:immunology / Q000401:mortality; D023921:Coronary Stenosis / Q000276:immunology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000276:immunology / Q000401:mortality*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000276:immunology / Q000401:mortality*; D012086:Reoperation; D015996:Survival Rate
D007166:Immunosuppressive Agents