title: Use of ventricular assist device as bridge to simultaneous heart and kidney transplantation in patients with cardiac and renal failure.
abstract: BACKGROUND
  Ventricular assist device (VAD) implantation as a bridge to cardiac transplantation is an effective treatment option for end-stage heart failure. Renal dysfunction is not uncommon but is considered to be a poor prognostic factor. We present our experience with 6 patients who had combined heart and kidney transplantation (HKT) after VAD implantation for advanced cardiac and renal failure.
  
  
  METHODS
  Of 74 patients who underwent VAD implantation as a bridge to transplant from May 2001 to September 2009, 28 patients developed renal failure, and of these, 6 (5 male, 1 female, ages 40-64 years) had HKT. All required hemodialysis because of renal failure before HKT. Immunosuppression consisted of anti-thymocyte globulin followed by triple drug therapy consisting of calcineurin inhibitors, mycophenolate, and corticosteroids.
  
  
  RESULTS
  Of the 6 HKT patients, 5 (83%) were alive without hemodialysis at 1 and 2 years; of the 22 patients with renal failure after VAD implantation without subsequent transplant, 1- and 2-year survivals were zero. Interval from VAD implantation to HKT ranged from 36 to 366 days (133 ± 127 days). At 6 months after HKT (100% alive), left ventricular ejection fraction was 60.2 ± 5.8% and serum creatinine 1.1 ± 0.2 mg/dL. Three HKT patients required temporary hemodialysis after surgery. Endomyocardial biopsy showed absence of ISHLT grade 2R-3A or greater cellular rejection, and none showed evidence of definite antibody-mediated rejection.
  
  
  CONCLUSIONS
  Based on our initial experience, simultaneous HKT is a safe treatment option with excellent outcomes for patients with advanced heart failure and persistent renal dysfunction after VAD implantation.
authors: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California 90048, USA.
authors: R
authors: R
authors: Yanagida
authors: L S C
authors: LS
authors: Czer
authors: A
authors: A
authors: Ruzza
authors: E R
authors: ER
authors: Schwarz
authors: S A
authors: SA
authors: Simsir
authors: S C
authors: SC
authors: Jordan
authors: A
authors: A
authors: Trento
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D059347:Cardio-Renal Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006353:Heart-Assist Devices; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D016276:Ventricular Function; D014850:Waiting Lists
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D003404:Creatinine