Simultaneous heart and kidney transplantation from a single donor

Abstract

There are no guidelines to establish the indications and contraindications for a simultaneous heart and kidney transplantation. We report our single-institutional experience with simultaneous heart and kidney transplantation. Retrospective chart review. Between 1995 and 2006, 13 patients with co-existing end-stage heart and renal failure underwent simultaneous heart and kidney transplantation at the authors' hospital. Heart failure was secondary to dilated cardiomyopathy in five patients, ischemic cardiomyopathy in three, cardiac allograft vasculopathy in two, and congenital heart disease, cardiac allograft failure, and acute myocarditis each in one. Renal failure was secondary to glomerulonephritis in six patients, heart failure in two, cyclosporine nephropathy in three, hypertension in one, and systemic lupus erythematosus in one. Eight patients were in UNOS status IA and five patients in UNOS status II before transplantation. The 30-day mortality rate and in-hospital mortality rate were 15% and 38%. Of eight patients in UNOS status IA, seven patients have lived beyond 30 days and three (38%) beyond 1 year. Of five patients in UNOS status II, four patients have lived beyond 30 days and four (80%) beyond 1 year. Patients in UNOS status IA had high rates of previous cardiac surgery, cardiac allograft rejection, and major renal allograft complications. Although simultaneous heart and kidney transplantation continues to be a viable option for patients with co-existing end-stage heart and renal failure, the results do not match those of isolated heart transplantation. The clinical outcomes were not satisfactory in UNOS status IA patients with previous cardiac surgery.