title: Outcomes of simultaneous heart-kidney and lung-kidney transplantations: the Australian and New Zealand experience.
abstract: BACKGROUND
  Heart or lung transplantation alone in individuals with significant pre-existing renal impairment results in high mortality and morbidity. Simultaneous heart-kidney (SHK) or simultaneous lung-kidney (SLK) transplantation may be considered in patients with dual organ failure not suitable for single organ transplantation.
  
  
  OBJECTIVE
  We aimed to outline the Australian and New Zealand experience of SHK and SLK transplantations, focussing on patient characteristics and survival.
  
  
  METHODS
  We analysed all SHK and SLK transplants performed in four centres across Australia and New Zealand between 1990 and 2014.
  
  
  RESULTS
  Over the study period, 35 SHK and 3 SLK transplants were performed across 4 transplant centres. Mean age at transplantation for SHK transplants was 45 years, and for SLK transplant was 27 years. The most common aetiology of renal failure was glomerulonephritis. Most SHK transplant patients (77%) required renal replacement therapy prior to transplantation, with only one of the three patients undergoing SLK transplant, dialysis dependent. One-year survival for the cohort was 79%, which is lower than reported for single organ transplantation. However, 5- and 10-year survivals of 76% and 68%, respectively, were comparable. Isolated renal graft loss was seen in five patients, with only one patient successfully re-transplanted and the rest commencing dialysis.
  
  
  CONCLUSIONS
  The Australian and New Zealand experience of SHK and SLK includes 38 patients with a high 1-year mortality, but excellent 5- and 10-year survivals. Based on this, it seems reasonable to continue to offer combined organ transplantation to select patients with dual organ failure.
authors.affiliation: Department of Renal Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: I
authors.initials: I
authors.lastname: Ruderman
authors.affiliation: Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Sevastos
authors.affiliation: Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Anthony
authors.affiliation: Department of Respiratory Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Ruygrok
authors.affiliation: Department of Renal Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: W
authors.initials: W
authors.lastname: Chan
authors.affiliation: Department of Renal Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Javorsky
authors.affiliation: Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Bergin
authors.affiliation: Department of Cardiology, Auckland City Hospital, Auckland, New Zealand.
authors.forename: G
authors.initials: G
authors.lastname: Snell
authors.affiliation: Department of Renal Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Menahem
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D005260:Female; D006085:Graft Survival; D016027:Heart Transplantation / Q000379:methods; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods; D016040:Lung Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D009520:New Zealand / Q000453:epidemiology; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: heart transplantation; kidney transplantation; lung transplantation; simultaneous heart/kidney transplantation; simultaneous lung/kidney transplantation