COMBINED HEART AND KIDNEY-TRANSPLANTATION USING THE SAME DONOR - 5 CASES

From 1988 to 1991, five patients received same donor heart and kidney transplants in our institution. All were male and mean age was 58 +/- 6 years (range, 46 to 64). The cardiac condition was dilated cardiomyo pathy in one case, end-stage ischemic disease in 3, and failed previou s cardiac transplantation in one. The renal condition requiring transp lantation was glomerular nephritis in one case, polycystic disease in 3, and renal cyclosporine A toxicity in one. All patients but one were under chronic hemodialysis. There were no hospital deaths. All five p atients are alive with a mean posttransplant follow-up of 22 +/- 10 mo nths (2 to 50 months). Five rejection episodes developed in three pati ents ; two patients have never experienced rejection of the heart tran splant. All patients but one recovered normal renal function within 7 days of transplantation; the single episode of renal rejection promptl y responded to corticosteroids. Episodes of heart and kidney rejection did not occur simultaneously, suggesting that tests for rejection sho uld be carried out separately for each transplant. Selective coronary arteriography was performed in four patients, 12, 12, 30, and 50 month s after the transplant, respectively, with normal results. These data suggest that combined heart and kidney transplantation is a realistic approach in carefully selected patients with both heart and kidney fai lure unresponsive to conventional methods.