COMBINED HEART-KIDNEY TRANSPLANTATION - REPORT ON 6 CASES

Background, Combined heart-kidney transplantation has become a new the rapeutic solution for patients with coexisting, irreversible heart and kidney failure. Though this combined approach has several theoretical advantages over sequential transplantation, it has yet to be establis hed that it does not jeopardize patient and graft outcomes. We here re port our experience with six cases of combined heart-kidney transplant ation from single donors and review the literature in order to clarify this issue. Methods. Four patients were kidney-transplant candidates with severe heart failure and two were heart-transplant candidates wit h independent chronic renal failure. Donors were selected on the basis of weight and size matching, ABO compatibility, and negative T-cell c ross-match. Results. The heart was always grafted first. The surgical procedure was uneventful in all cases. Heart and kidney function recov ered quickly in all patients. Two patients died, one at day 45 from he art subacute rejection and the other one at day 157 from cerebral haem orrhage. The four remaining patients are alive 23-84 months after tran splantation (2-year survival rate: 67%) and have well-functioning kidn eys (creatinine clearance 31-83 ml/min) and hearts (left ventricular e jection fraction 53-83%). Remarkably, four of six patients had no acut e rejection episode of either organ. These patient and graft outcomes are in agreement with previous reports and compare favourably with the results of isolated heart and kidney transplantation. Conclusions. Co mbined heart-kidney transplantation from the same donor should be prop osed to patients who would qualify for transplantation of each organ w ithin a few years.