Combined heart and kidney transplantation: long-term analysis of renal function and major adverse events at 20 years.
BACKGROUND
Combined heart-kidney transplantation (HKTx) is an accepted therapeutic option for patients with end-stage heart disease associated with severely impaired renal function. We report our long-term follow-up with this combined procedure.


METHODS
Between April 1989 to November 2009, nine patients underwent combined simultaneous (HKTx) at our center. Seven patients were males (mean age 45.2 +/- 10.12 years); seven patients were on dialysis at the time of transplantation.


RESULTS
Surgical procedures were uneventful in all patients. One patient died in the intensive care unit 41 days after transplantation. During long-term follow-up, three patients died: one due to infection and multiorgan failure 148 months after HKTx, one due to a lung neoplasm after 6 years, and one, a cerebral stroke at 34 months after transplantation. Only one patient experience renal allograft failure secondary to hypertension and cyclosporine nephrotoxicity at 10 years after HKTx with the need for renal replacement therapy. Last estimated glomerular filtration rates of all other patients was 61.3 +/- 17.4 mL/min.


CONCLUSIONS
In selected patients, with coexisting end-stage cardiac and renal failure, combined HKTx with an allograft from the same donor proved to give satisfactory short- and long-term results, with a low incidence of both cardiac and renal allograft complications.
Cardiology & Cardiac Surgery Department A De Gasperis, Niguarda Ca' Granda Hospital, Milan, Italy. giuseppe.bruschi@fastwebnet.it
G
G
Bruschi
L
L
Botta
T
T
Colombo
G
G
Busnach
G
G
Pedrazzini
A
A
Cannata
S
S
Trunfio
F
F
Macera
F
F
Turazza
F
F
Oliva
C V
CV
Sansalone
R
R
Paino
M
M
Frigerio
L
L
Martinelli
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006331:Heart Diseases / Q000150:complications / Q000601:surgery*; D006333:Heart Failure / Q000150:complications / Q000601:surgery; D016027:Heart Transplantation / Q000473:pathology / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000601:surgery; D007674:Kidney Diseases / Q000150:complications / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery; D016030:Kidney Transplantation / Q000473:pathology / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D014019:Tissue Donors; D016896:Treatment Outcome