title: Difficulty of patient selection in a combined heart-kidney transplant: a case report.
abstract: Combined heart-kidney transplant has become an alternative for heart transplant candidates with significant chronic kidney disease. However, it is not clear which patients will benefit most from such intervention, and in whom cardiac transplant alone will be sufficient to restore adequate renal function. We report the case of a man with ischemic cardiomyopathy and chronic kidney disease who was wait-listed for heart-kidney transplant after acute decompensated heart failure and renal failure requiring hemodialysis. Because of unexpected circumstances, the kidney transplant was cancelled, and only a heart transplant was performed. Nonetheless, the kidney function rapidly improved beyond the levels before hospitalization and remains stable months after transplant. This case illustrates the difficulties in assessing the reversibility of kidney damage in the context of heart failure requiring transplant. This issue is primordial to improve selection of patients who will benefit most from combined heart-kidney transplant in a context of scarce organ allocation resources.
authors.affiliation: From the Nephrology and Kidney Transplantation Department, Hôpital Maisonneuve-Rosemont, Québec, Canada.
authors.forename: Rémi
authors.initials: R
authors.lastname: Goupil
authors.forename: Alain
authors.initials: A
authors.lastname: Bonnardeaux
authors.forename: Anne
authors.initials: A
authors.lastname: Boucher
authors.forename: Suzon
authors.initials: S
authors.lastname: Collette
authors.forename: Denis
authors.initials: D
authors.lastname: Ouimet
authors.forename: Lynne
authors.initials: L
authors.lastname: Sénécal
authors.forename: Duy
authors.initials: D
authors.lastname: Tran
authors.forename: Michel
authors.initials: M
authors.lastname: Vallée
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications*; D018579:Patient Selection; D020127:Recovery of Function; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left