title: Combined Heart and Kidney Transplantation: A 23-Year Experience.
abstract: BACKGROUND
  We report clinical experience with combined heart and kidney transplantation (HKTx) over a 23-year time period.
  
  
  METHODS
  From June 1992 to August 2015, we performed 83 combined HKTx procedures at our institution. We compared the more recent cohort of 53 HKTx recipients (group 2, March 2009 to August 2015) with the initial 30 previously reported HKTx recipients (group 1, June 1992 to February 2009). Pre-operative patient characteristics, peri-operative factors, and post-operative outcomes including survival were examined.
  
  
  RESULTS
  The baseline characteristics of the two groups were similar, except for a lower incidence of ethanol use and higher pre-operative left-ventricular ejection fraction, cardiac output, and cardiac index in group 2 when compared with group 1 (P = .007, .046, .037, respectively). The pump time was longer in group 2 compared with group 1 (153.30 ± 38.68 vs 129.60 ± 37.60 minutes; P = .007), whereas the graft ischemic time was not significantly different between the groups, with a trend to a longer graft ischemic time in group 2 versus group 1 (195.17 ± 45.06 vs 178.07 ± 52.77 minutes; P = .056, respectively). The lengths of intensive care unit (ICU) and hospital stay were similar between the groups (P = .083 and .39, respectively). In addition, pre-operative and post-operative creatinine levels at peak, discharge, 1 year, and 5 years and the number of people on post-operative dialysis were similar between the groups (P = .37, .75, .54, .87, .56, and P = .139, respectively). Overall survival was not significantly different between groups 2 and 1 for the first 5 years after transplant, with a trend toward higher survival in group 2 (P = .054).
  
  
  CONCLUSIONS
  The most recent cohort of combined heart and kidney transplant recipients had similar ICU and hospital lengths of stay and post-operative creatinine levels at peak, discharge, and 1 and 5 years and a similar number of patients on post-operative dialysis when compared with the initial cohort. Overall survival was not significantly different between the later and earlier groups, with a trend toward higher overall survival at 5 years in the more recent cohort of patients. In selected patients with co-existing heart and kidney failure, combined heart and kidney transplantation is safe to perform and has excellent outcomes.
authors.affiliation: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: M
authors.initials: M
authors.lastname: Awad
authors.affiliation: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: lawrence.czer@cshs.org.
authors.forename: L S C
authors.initials: LS
authors.lastname: Czer
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: F
authors.initials: F
authors.lastname: Esmailian
authors.affiliation: Division of Pediatric Nephrology, Cedars-Sinai Medical Center, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: S
authors.initials: S
authors.lastname: Jordan
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: M A
authors.initials: MA
authors.lastname: De Robertis
authors.affiliation: Section of Biostatistics and Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: J
authors.initials: J
authors.lastname: Mirocha
authors.affiliation: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: J
authors.initials: J
authors.lastname: Patel
authors.affiliation: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: D H
authors.initials: DH
authors.lastname: Chang
authors.affiliation: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: M
authors.initials: M
authors.lastname: Kittleson
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: D
authors.initials: D
authors.lastname: Ramzy
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: F
authors.initials: F
authors.lastname: Arabia
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: J S
authors.initials: JS
authors.lastname: Chung
authors.affiliation: Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: J L
authors.initials: JL
authors.lastname: Cohen
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: A
authors.initials: A
authors.lastname: Trento
authors.affiliation: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: J A
authors.initials: JA
authors.lastname: Kobashigawa
mesh_terms: D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011182:Postoperative Care; D051437:Renal Insufficiency / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome