Combined heart-kidney transplant improves post-transplant survival compared with isolated heart transplant in recipients with reduced glomerular filtration rate: Analysis of 593 combined heart-kidney transplants from the United Network Organ Sharing Database

Karamlou, Tara; Welke, Karl F.; McMullan, D. Michael; Cohen, Gordon; Gelow, Jill M.; Tibayan, Frederick A.; Mudd, James M.; Slater, Matthew S.; Song, Howard K.

doi:10.1016/j.jtcvs.2013.09.017

Cited by 121 publications

(126 citation statements)

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“…По мнению T. Karamlou с соавт. [6], это обусловле но непредсказуемостью изменения функции почки после ТС. В описанном случае умеренная дисфун кция сердечного трансплантата в раннем послеопе рационном периоде второй трансплантации сердца могла стать одной из причин утраты функции перво го почечного трансплантата.…”

Section: клинический примерunclassified

“…Потребность в ПТСП постоянно растет, что под тверждается и общемировым опытом [6,9]. В на шем Центре на сегодняшний день наблюдаются 6 реципиентов сердечного трансплантата, находя щихся на диализной терапии и включенных в лист ожидания трансплантации почки.…”

Section: клинический примерunclassified

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Kidney injury and renal replacement therapy in heart transplant recipient

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et al. 2017

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The development of kidney injury and the characteristics of renal replacement therapy were considered in patient with dilated cardiomyopathy, who consequently underwent two heart transplantations and two kidney transplantations. Since the number of the patients needed both kidney and heart transplantation increases constantly, the multifaceted thorough research in this specific patient population is extremely important.

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Section: клинический примерunclassified

Kidney injury and renal replacement therapy in heart transplant recipient

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et al. 2017

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“…Lower eGFR is a risk factor for death after heart transplant (59). Five years after a heart transplant alone, 11% of recipients will require RRT or have an eGFR,30 ml/min per 1.73 m 2 (60).…”

Section: What Is the Evidence To Support Left Ventricular Devices Fromentioning

confidence: 99%

“…The authors concluded that SHK should be considered in heart transplant candidates with kidney failure requiring dialysis, but that for kidney disease not requiring dialysis, further study is needed (61). Another study from the United Network for Organ Sharing identified 26,183 heart transplant recipients and 593 SHK recipients and noted that heart transplant recipients with eGFR,37 ml/min per 1.73 m 2 had worse survival than SHK recipients (59).…”

Section: What Is the Evidence To Support Left Ventricular Devices Fromentioning

confidence: 99%

A Patient with Heart Failure and Worsening Kidney Function

Sarnak¹

2014

Clinical Journal of the American Society of Nephrology

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There is high prevalence of CKD, defined by reduced GFR, in patients with heart failure. Reduced kidney function is associated with increased morbidity and mortality in this patient population. The cardiorenal syndrome (CRS) involves a bidirectional relationship between the heart and kidneys whereby dysfunction in either may exacerbate the function of the other, but this syndrome has been difficult to precisely define because it has many complex physiologic, biochemical, and hormonal abnormalities. The pathophysiology of CRS is not completely understood, but potential mechanisms include reduced kidney perfusion due to decreased forward flow, increased right ventricular and venous pressure, and neurohormonal adaptations. Treatment options include inotropic medications; diuretics; ultrafiltration; and medications, such as b-blockers, inhibitors of the renin-angiotensinaldosterone system, and more novel treatments that focus on unique aspects of the pathophysiology. Recent observational studies suggest that treatments that result in a decrease in venous pressure and lead to hemoconcentration may be associated with improved outcomes. Patients with CRS that is not responsive to medical interventions should be considered for ventricular assist devices, heart transplantation, or combined heart and kidney transplantation.Clin J Am Soc Nephrol 9: 1790-1798, 2014. doi: 10.2215/CJN.11601113 Case PresentationOur patient is a 56-year-old man with ischemic cardiomyopathy who has had several admissions for worsening shortness of breath, lower-extremity edema, and increased abdominal girth. He was readmitted with the same symptoms. His medical history is significant for coronary artery disease, coronary artery bypass surgery performed 9 years before admission, mitral and tricuspid valve repair, atrial fibrillation with failed cardioversion, nonsustained ventricular tachycardia with an implantable cardiac defibrillator, pulmonary hypertension, severe hyperlipidemia treated with lipid apheresis using an arteriovenous fistula, and CKD with a baseline creatinine level of 1.5-2 mg/dl.Outpatient oral medications included furosemide, 60 mg in the morning and 40 mg in the evening; carvedilol, 12.5 mg twice daily; hydrochlorothiazide, 25 mg daily; digoxin, 0.125 mg daily; aspirin, 81 mg daily; mexiletine, 150 mg three times daily; and warfarin, 3 mg daily. He had intolerance to angiotensin-converting enzyme (ACE) inhibitors and statins.Pertinent physical examination findings included BP, 130/74 mmHg; heart rate, 84 beats/min; respiratory rate, 18 breaths/min; and weight, 88.7 kg (increased .10 kg during the last few months). Jugular venous pressure was elevated to the angle of the jaw with the patient at 45 degrees. Heart rate was irregular, with a II/VI systolic murmur loudest at the left sternal border. There were bibasilar crackles, tense ascites, and 21 pitting edema bilaterally up to the knees. He had an arteriovenous fistula in his left arm.Laboratory results were as follows: sodium, 131 mEq/L; potassium, 3.8 mEq/L; chlori...

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“…Выделяют одномоментную, или симультанную (simultaneous), трансплантацию сердца-почки от одного и того же донора, а также последовательные (staged) транс-плантации сердца и почки от двух генетически раз-личных доноров [1]. В соответствии с протоколом «UNOS-Standard Transplant Analysis and Research» симультанной, или одномоментной, следует счи-тать трансплантацию сердца и почки, выполненную одна за другой в интервале не более 24 ч [2].…”

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Combined Heart-Kidney Transplantation

Попцов

2016

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ФГБУ «Федеральный научный центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России, Москва, Российская Федерация Сочетанная трансплантация сердца и почки является одним из возможных направлений эффективно-го лечения больных c сочетанием терминальной застойной сердечной недостаточности (ЗСН) и почеч-ной недостаточности. Выделяют одномоментную, комбинированную, или симультанную (simultaneous), трансплантацию сердце-почка (КТСП) от одного и того же донора, а также последовательные (staged) трансплантации сердца и почки от двух генетически различных доноров. ISHLT также отмечает рост числа ежегодно выполняемых КТСП -от 22 (1994 г.) до 97 (2012 г.). В статье приводится мировой опыт выполнения КТСП, обсуждаются показания к ее выполнению, в том числе у пациентов с диализ-незави-симой почечной недостаточностью. Отмечается, что особенностью КТСП по сравнению с изолирован-ной ТС и аллотрансплантацией трупной почки является меньшая частота и выраженность отторжения как сердечного, так и почечного трансплантата, а также частота возникновения болезни коронарных ар-терий пересаженного сердца. Приводится собственный опыт двух последовательных трансплантаций сердца и почки. Обсуждаются показания для одномоментной (симультанной) и последовательной транс-плантации сердца и почки. Ключевые слова: трансплантация сердца, трансплантация почки. COMBINED HEART-KIDNEY TRANSPLANTATION V.N. Poptsov V.I. Shumakov Federal Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russian FederationCombined heart-kidney transplantation may be performed in carefully selected patients with end-stage heart disease and renal failure. There are two types of combined transplantation of heart and kidney: 1) simultaneous heart-kidney transplantation (SHKT) from the same donor; 2) staged transplantation of heart and kidneys from two genetically different donors. The ISHLT registry in 2014 reported an increase in the number of SHKT over the years: from 22 in 1994 to 97 in 2012. World experience demonstrated excellent results of SHKT. Recipients of SHKT had superior survival, lower rates of acute cardiac and renal rejection compared to heart recipients. This article discusses the indications for simultaneous or staged heart-kidney transplantation in patients with dialysis-independent or dialysis-dependent renal failure, results and posttransplant survival of SHKT recipients. The author describes his own experience of 2 staged combined heart-kidney transplantations.

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Combined heart-kidney transplant improves post-transplant survival compared with isolated heart transplant in recipients with reduced glomerular filtration rate: Analysis of 593 combined heart-kidney transplants from the United Network Organ Sharing Database

Abstract: Performance of combined HKTx is increasing out of proportion to isolated HTx. eGFR is an important determinant of improved HTx survival. Combined HKTx recovers post-transplant survival in patients with eGFR <37 mL/minute and can be recommended in this subgroup.

Cited by 121 publications

References 19 publications

Kidney injury and renal replacement therapy in heart transplant recipient

Kidney injury and renal replacement therapy in heart transplant recipient

A Patient with Heart Failure and Worsening Kidney Function

Combined Heart-Kidney Transplantation

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