J. Bergler-klein et al., The long-term effect of simultaneous heart and kidney transplantation on native renal function, TRANSPLANT, 71(11), 2001, pp. 1597-1600
Background, It is unclear whether patients with heart failure and renal ins
ufficiency should receive a simultaneous heart and kidney transplant or whe
ther a single heart transplantation is sufficient to restore native renal f
unction.
Methods. We analyzed the renal plasma flow and glomerular filtration of the
native and transplant kidneys in eight patients long term after simultaneo
us heart and kidney transplantation using a dynamic MAG3 radioisotope scan
and serum creatinine determinations. All subjects had been hemodialysis dep
endent before transplantation. Seven patients suffered from an intrinsic re
nal disease that were diabetic nephropathy in three cases, small fibrotic k
idneys of undetermined origin in two cases, one lupus nephritis, and cyclos
porine nephrotoxicity in one patient who had a previous heart transplant, I
n one patient renal insufficiency was considered to be solely due to renal
hypoperfusion because no intrinsic renal disease could be detected.
Results. All patients were on cyclosporine-based triple immunosuppression,
transplanted for 4 to 10 years, exhibited cardiac ejection fractions of mor
e than 50% and had normal serum creatinine values. Radioisotopic scan showe
d no function of the native kidneys in all seven patients with intrinsic re
nal disease but exhibited normal function of the native kidneys as well as
the renal transplant in the patient without intrinsic kidney disease before
transplantation.
Conclusions. These data suggest that a simultaneous heart and kidney transp
lantation is necessary in patients with cardiomyopathy and renal insufficie
ncy due to primary kidney disease, but not in those with hemodynamically me
diated renal failure, even if an immunosuppressive regimen with calcineurin
inhibitors is used.