Combined heart-kidney transplantation: report on six cases

Col, V.; Jacquet, Luc‐Marie; Squifflet, Jean‐Paul; Goenen, Martin; Noirhomme, Philippe; Goffin, Éric; Pirson, Yves

doi:10.1093/ndt/13.3.723

Cited by 20 publications

(14 citation statements)

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“…We found that recipients of SHK transplants had substantially lower rates of acute cardiac rejection and acute renal rejection at 1-year posttransplant compared to their respective comparator groups. The cardiac acute rejection rate at 1 year in SHK was 14.5% in our study that agrees with earlier studies (3,4) and the rate of renal acute rejection was less than 7%, despite no zero-mismatch transplants in this group. This is in keeping with suggestions in previous studies that partial graft tolerance in simultaneous multiorgan transplantation may lead to a decrease in the acute rejection rate compared to single organ transplants.…”

Section: Lower Acute Rejection Rates In Shksupporting

confidence: 93%

Outcomes of Simultaneous Heart–Kidney Transplant in the US: A Retrospective Analysis Using OPTN/UNOS Data

Gill

Shah

Hristea

et al. 2009

American Journal of Transplantation

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Simultaneous heart-kidney transplantation (SHK) remains uncommon in the US. We examined outcomes of SHK compared to heart transplant alone (HTA) and deceased donor kidney transplant (DDKT).Data from OPTN/UNOS heart and kidney data bases were used to identify 16 710 HTA, 263 SHK transplants and 68 833 DDK transplants between 1998 and 2007. Outcomes included patient survival (PS), acute cardiac and renal rejection and renal graft survival (rGS).The adjusted risk of death was 44% lower with SHK compared to HTA. Over half of SHK were performed in cases where pretransplant dialysis was not initiated. In these cases, there was no significant difference in the risk of death between SHK and HTA (HR 1.01; 95% CI 0.67-1.50).Recipients of SHK had worse 1-year rGS and PS and had a higher relative risk of overall renal graft loss compared to DDKT recipients. One-year rates of cardiac (14.5%) and renal (6.5%) rejection were lower in SHK compared to HTA and DDKT, respectively.Recipients of SHK had a lower adjusted risk of death compared to HTA recipients, particularly in patients who required pretransplant dialysis. These data suggest that SHK should be considered in heart transplant candidates with renal failure requiring dialysis, whereas the utility of SHK in cases of renal failure not requiring dialysis warrants further study.

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Section: Lower Acute Rejection Rates In Shksupporting

confidence: 93%

Outcomes of Simultaneous Heart–Kidney Transplant in the US: A Retrospective Analysis Using OPTN/UNOS Data

Gill

Shah

Hristea

et al. 2009

American Journal of Transplantation

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“…Patient outcomes of HKT appear similar to HTA. 4,5,[13][14][15][16] Although still marginal, HKT is increasingly performed despite the lack of good evidence regarding patient selection.…”

Section: Discussionmentioning

confidence: 99%

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Goupil

Bonnardeaux²,

Boucher³

et al. 2014

Exp Clin Transplant

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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.

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“…El trasplante renal diferido no presenta diferencias respecto del trasplante renal en un paciente sin trasplante cardíaco ya que se hace en un paciente estable y de la forma habitual y con los criterios de selección habituales, si bien la inmunosupresión que se utiliza es la del cardíaco 10 . En los casos simultáneos, si bien la técnica quirúrgica del trasplante renal es la misma, se hace en un paciente en peor situación clínica lo que conlleva una mayor mortalidad peroperatoria que puede llegar hasta un 21% 3,7,8,15 ; en estos casos de trasplante simultáneo los criterios de selección del donante se basan fundamentalmente en la compatibilidad ABO y una prueba cruzada negativa sin tener en cuenta la compatibilidad HLA 4, 13,[15][16][17] ; además se benefician de un tiempo menor de isquemia fría, que al igual que en nuestros casos está en torno a las 6 horas 4,12,15 .…”

Section: Discussionunclassified

“…Este fenómeno de protección frente al rechazo podría resultar de la inmunomodulación del receptor por el trasplante simultáneo o por la introducción de elementos hematopoyéticos 19 . En las diferentes series entre el 62 y 100% de los pacientes con trasplante simultáneo cardio-renal no tuvieron episodios de rechazo agudo 2,3,13,14,16 . Narula 8 en su registro multicéntrico encuentra que en el 48% de los casos no hubo rechazo, 27% le tuvo solo en el corazón, el 14% solo en el riñón y el 11% en los dos, concluyendo que el rechazo cardíaco es menor en los trasplantes combinados que en el aislado.…”

Section: Discussionunclassified