title: Combined heart and kidney transplantation provides an excellent survival and decreases risk of cardiac cellular rejection and coronary allograft vasculopathy.
abstract: BACKGROUND
  We analyzed the results of combined heart-kidney transplantation (CHKTx) over a 10-year period.
  
  
  METHODS
  Between September 1996 and May 2007 at Mayo Clinic, 12 patients (age 52 ± 12.2 years) underwent CHKTx as a simultaneous procedure in 10 recipients and as a staged procedure in two recipients with unstable hemodynamics after heart transplantation.
  
  
  RESULTS
  There was no operative mortality. Patient survival rates for the CHKTx recipients at 1 and 3 months and 6 years were 91%, 83%, and 83% and did not differ from isolated heart transplantation (IHTx) recipients (97%, 95%, and 79%, P = 0.61). The freedom from cardiac allograft rejection (≥ grade 2) at 3 months was 73% for CHKTx and had not changed during further follow-up; for IHTx, freedom from rejection at 3 months and 1 and 6 years was 61%, 56%, and 42% (P = .08). Heart and renal allograft survival was 100% with and left ventricular ejection fraction 66% ± 8.4% and glomerular filtration rate 61 ± 25 at last follow-up. There were no signs of cardiac allograft vasculopathy in the CHKTx recipients.
  
  
  CONCLUSIONS
  CHKTx yields favorable long-term outcome, with a low incidence of cardiac rejection and vasculopathy. Simultaneous CHKTx appears feasible, if hemodynamics is satisfactory. This approach expands the selection criteria for transplantation in patients with coexisting end-stage cardiac and renal disease.
authors.affiliation: Internal Medicine-Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska68198-2265, USA. eraichlin@unmc.edu
authors.forename: E
authors.initials: E
authors.lastname: Raichlin
authors.forename: S S
authors.initials: SS
authors.lastname: Kushwaha
authors.forename: R C
authors.initials: RC
authors.lastname: Daly
authors.forename: W K
authors.initials: WK
authors.lastname: Kremers
authors.forename: R P
authors.initials: RP
authors.lastname: Frantz
authors.forename: A L
authors.initials: AL
authors.lastname: Clavell
authors.forename: R J
authors.initials: RJ
authors.lastname: Rodeheffer
authors.forename: T S
authors.initials: TS
authors.lastname: Larson
authors.forename: M D
authors.initials: MD
authors.lastname: Stegall
authors.forename: C
authors.initials: C
authors.lastname: McGregor
authors.forename: N L
authors.initials: NL
authors.lastname: Pereira
authors.forename: B S
authors.initials: BS
authors.lastname: Edwards
mesh_terms: D000328:Adult; D003331:Coronary Vessels / Q000473:pathology / Q000637:transplantation*; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate