title: Clinical characteristics and long-term outcomes of patients undergoing combined heart-kidney transplantation: a single-center experience.
abstract: BACKGROUND
  The purpose of the study was to describe clinical characteristics and long-term survival of patients undergoing combined heart-kidney transplant in a single center.
  
  
  METHODS
  We conducted a retrospective analysis of 22 consecutive patients who underwent combined heart-kidney transplant at our institution between 1995 and 2013. Long-term outcomes were analyzed by means of the Kaplan-Meier method.
  
  
  RESULTS
  Four patients underwent re-do transplant (2 cardiac re-transplants, 1 kidney re-transplant, and 1 combined heart-kidney re-transplant). Most frequent underlying cardiac conditions were coronary artery disease (54%), dilated cardiomyopathy (23%), and chronic rejection of a previous heart graft (18%). Known causes of chronic renal dysfunction were nephroangioesclerosis (23%), drug-related toxicity (14%), and Wegener granulomatosis (5%). Non-specified chronic renal dysfunction was present in 50% patients. In-hospital postoperative mortality rate was 5 of 22 (23%). Causes of early death were directly related to kidney transplant surgery in 4 of 5 (80%) patients. Among the remaining 17 patients who surmounted the postoperative period, long-term survival rates 1 year, 5 years, and 10 years after HKT were 88%, 82%, and 65%, respectively. Over a mean follow-up of 6.7 ± 6.4 years, cumulative incidences of cytomegalovirus infection, coronary allograft vasculopathy, malignancy, and acute cardiac graft rejection were 41%, 6%, 24%, and 41%, respectively. There was no episode of acute renal graft rejection. At the end of follow-up, all survivors (n = 11) were in functional New York Heart Association class I. Mean creatinine serum level was 1.68 mg/dL.
  
  
  CONCLUSIONS
  In our experience, combined heart-kidney transplant is a feasible therapeutic option that yielded favorable long-term outcomes, with a low cumulative incidence of cardiac graft dysfunction. These results were obtained at the expense of a significant risk of early postoperative mortality, which was mainly related to complications of kidney transplant surgery.
authors: Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain. Electronic address: kelals@hotmail.com.
authors: Á
authors: Á
authors: López-Sainz
authors: Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors: E
authors: E
authors: Barge-Caballero
authors: Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors: M J
authors: MJ
authors: Paniagua-Martin
authors: Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors: R
authors: R
authors: Marzoa Rivas
authors: Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors: G
authors: G
authors: Sánchez-Fernández
authors: Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Servicio de Cirugía Cardiaca, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors: L
authors: L
authors: Fernández Arias
authors: Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Servicio de Cirugía Cardiaca, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors: M
authors: M
authors: García-Vieites
authors: Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Servicio de Nefrología, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors: Á
authors: Á
authors: Alonso-Hernández
authors: Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Servicio de Urología, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors: J J
authors: JJ
authors: Rodríguez-Rivera-García
authors: Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors: M G
authors: MG
authors: Crespo-Leiro
mesh_terms: D000368:Aged; D005260:Female; D006085:Graft Survival; D006331:Heart Diseases / Q000209:etiology; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies