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

From 1988 to 1991, five cases of combined heart and kidney transplanta tion using the same donor have been achieved at our institution.All pa tients weres males, 58 +/- 6 (46 to 64). The cardiac condition leading to the cardiac replacement was a dilated cardiomyopathy in one case, end-stage ischemic disease in 3, and failure of a previous cardiac tra nsplantation in one. The renal condition claiming for a graft was a Gl omerular nephritis in one, a polycystic disease in 3, and renal failur e due to CyA toxicity in one; chronic hemodialysis was mandatory in al l patients but one. There were no hospital deaths. The five patients a re current survivors, the mean follow-up beeing 22 +/- 10 mths (2-50 m ths). Five rejection episodes occured in three patients ; two patients have never demonstrated any cardiac rejection. All but one recovered a normal renal function as soon as the 7 th post operative day ; only one episode of renal rejection has been detected, easily reversed by c orticoids. No simultaneity was ever observed between cardiac and renal rejection episodes. Thus, the detection of rejection must be carried out separately for each graft organ. In four patients, cineangiograms of the coronary vessels were done respectively 12, 30 and 50 months po st operatively and revealed a normal coronary bed. Thus, combined hear t and kidney transplantation seems to be a realistic approach in prope rly selected patients in whom cardiac and renal failures cannot be tre ated by more conventionnal procedures.