Intraoperative Considerations and Management of Simultaneous Heart Kidney Transplantation

Abstract

Patients with heart failure are prone to developing non-cardiovascular comorbidities throughout the course of their disease. In particular, renal impairment is widespread in this patient population. The number of heart-kidney transplants has increased significantly over the past 2 decades. Currently, there is no consensus on therapies for patients who may need dual-organ transplants. The optimal timing of dual-organ transplantation is still debated. The options for the timing of dual-organ transplants are simultaneous, staged, or delayed. In this manuscript, the authors review their institutional experience with the intraoperative management of simultaneous heart-kidney transplants (SHKT) and discuss their outcomes, including cardiac primary graft dysfunction (PGD) and renal delayed graft function (DGF). A total of 31 patients were included in the SHKT study group. Data analysis revealed that no patients required newly initiated mechanical circulatory support (MCS) post-operatively, and 11 of 31 patients were placed on renal replacement therapy within 7 days postoperatively. Patients who did have post-operative MCS were intra-aortic balloon pumps that were present before the transplant and then removed on postoperative day 1. No patient required additional MCS after the transplant. The increasing number of patients having heart and kidney transplants demonstrates a need for developing a perioperative management protocol. The results of our experience validate our intraoperative management. None of the patients developed moderate or severe cardiac PGD, and 35% had renal DGF. With further studies, the eventual development of guidelines for patient selection and management for SHKT also may be possible.