Long-Term Follow-Up of Simultaneous Heart and Kidney Transplantation With Single Donor Allografts

Report of Nine Cases

Giuseppe Bruschi, Ghil Busnach, Tiziano Colombo, Loredana Radaelli, Giovanna Pedrazzini, Andrea Garatti, Cosimo V. Sansalone, Maria Frigerio, Ettore Vitali

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Combined heart-kidney transplantation is an accepted therapeutic option for patients with end-stage heart disease associated with severely impaired renal function. We report our single-institutional experience with this combined procedure and long-term follow-up. Methods: Between April 1989 and August 2006, 9 patients underwent combined simultaneous heart-kidney transplantation at our center. Seven patients were male (mean age, 45.2 ± 10.12 years); 7 patients were on dialysis at transplantation. Whenever possible, donors were selected on the basis of ABO identity, weight (ratio ≥ 0.9), on-site or short-distance procurement, young age, low inotropic support, and normal renal function. Results: Mean ischemic time was 132.2 ± 57.0 minutes for the cardiac allograft and 6.0 ± 1.0 hours for the kidney. Surgical procedure was uneventful in all patients. One patient died in the intensive care unit 41 days after transplantation. Three patients died during follow-up, 1 of lung neoplasm after 6 years, 1 of cerebral stroke after 34 months, and 1 of infection and multiorgan failure after 148 months. The mortality rates led to an overall actuarial survival of 88.9% ± 10.4% at 1 year, 77.8% ± 13.6% at 5 years, and 64.8% ± 16.5% at 10 years. Seven patients lived beyond 5 years, 4 beyond 10 years, and the patient who has longest survival is patient no. 1, with 17 years of follow-up. One patient lost kidney function after 113 months. Conclusions: In selected patients, with coexisting end-stage cardiac and renal failure, combined heart-kidney transplantation with allograft from the same donor proved to have satisfactory short- and long-term results, with a low incidence of both cardiac and renal allograft rejection.

Original languageEnglish
Pages (from-to)522-527
Number of pages6
JournalAnnals of Thoracic Surgery
Volume84
Issue number2
DOIs
Publication statusPublished - Aug 2007

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Heart Transplantation
Kidney Transplantation
Allografts
Tissue Donors
Kidney
Transplantation
Survival
Chronic Kidney Failure
Intensive Care Units
Dialysis
Heart Diseases
Lung Neoplasms
Heart Failure
Stroke
Weights and Measures

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Long-Term Follow-Up of Simultaneous Heart and Kidney Transplantation With Single Donor Allografts : Report of Nine Cases. / Bruschi, Giuseppe; Busnach, Ghil; Colombo, Tiziano; Radaelli, Loredana; Pedrazzini, Giovanna; Garatti, Andrea; Sansalone, Cosimo V.; Frigerio, Maria; Vitali, Ettore.

In: Annals of Thoracic Surgery, Vol. 84, No. 2, 08.2007, p. 522-527.

Research output: Contribution to journalArticle

Bruschi, G, Busnach, G, Colombo, T, Radaelli, L, Pedrazzini, G, Garatti, A, Sansalone, CV, Frigerio, M & Vitali, E 2007, 'Long-Term Follow-Up of Simultaneous Heart and Kidney Transplantation With Single Donor Allografts: Report of Nine Cases', Annals of Thoracic Surgery, vol. 84, no. 2, pp. 522-527. https://doi.org/10.1016/j.athoracsur.2007.04.018
Bruschi, Giuseppe ; Busnach, Ghil ; Colombo, Tiziano ; Radaelli, Loredana ; Pedrazzini, Giovanna ; Garatti, Andrea ; Sansalone, Cosimo V. ; Frigerio, Maria ; Vitali, Ettore. / Long-Term Follow-Up of Simultaneous Heart and Kidney Transplantation With Single Donor Allografts : Report of Nine Cases. In: Annals of Thoracic Surgery. 2007 ; Vol. 84, No. 2. pp. 522-527.
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abstract = "Background: Combined heart-kidney transplantation is an accepted therapeutic option for patients with end-stage heart disease associated with severely impaired renal function. We report our single-institutional experience with this combined procedure and long-term follow-up. Methods: Between April 1989 and August 2006, 9 patients underwent combined simultaneous heart-kidney transplantation at our center. Seven patients were male (mean age, 45.2 ± 10.12 years); 7 patients were on dialysis at transplantation. Whenever possible, donors were selected on the basis of ABO identity, weight (ratio ≥ 0.9), on-site or short-distance procurement, young age, low inotropic support, and normal renal function. Results: Mean ischemic time was 132.2 ± 57.0 minutes for the cardiac allograft and 6.0 ± 1.0 hours for the kidney. Surgical procedure was uneventful in all patients. One patient died in the intensive care unit 41 days after transplantation. Three patients died during follow-up, 1 of lung neoplasm after 6 years, 1 of cerebral stroke after 34 months, and 1 of infection and multiorgan failure after 148 months. The mortality rates led to an overall actuarial survival of 88.9{\%} ± 10.4{\%} at 1 year, 77.8{\%} ± 13.6{\%} at 5 years, and 64.8{\%} ± 16.5{\%} at 10 years. Seven patients lived beyond 5 years, 4 beyond 10 years, and the patient who has longest survival is patient no. 1, with 17 years of follow-up. One patient lost kidney function after 113 months. Conclusions: In selected patients, with coexisting end-stage cardiac and renal failure, combined heart-kidney transplantation with allograft from the same donor proved to have satisfactory short- and long-term results, with a low incidence of both cardiac and renal allograft rejection.",
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AU - Radaelli, Loredana

AU - Pedrazzini, Giovanna

AU - Garatti, Andrea

AU - Sansalone, Cosimo V.

AU - Frigerio, Maria

AU - Vitali, Ettore

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N2 - Background: Combined heart-kidney transplantation is an accepted therapeutic option for patients with end-stage heart disease associated with severely impaired renal function. We report our single-institutional experience with this combined procedure and long-term follow-up. Methods: Between April 1989 and August 2006, 9 patients underwent combined simultaneous heart-kidney transplantation at our center. Seven patients were male (mean age, 45.2 ± 10.12 years); 7 patients were on dialysis at transplantation. Whenever possible, donors were selected on the basis of ABO identity, weight (ratio ≥ 0.9), on-site or short-distance procurement, young age, low inotropic support, and normal renal function. Results: Mean ischemic time was 132.2 ± 57.0 minutes for the cardiac allograft and 6.0 ± 1.0 hours for the kidney. Surgical procedure was uneventful in all patients. One patient died in the intensive care unit 41 days after transplantation. Three patients died during follow-up, 1 of lung neoplasm after 6 years, 1 of cerebral stroke after 34 months, and 1 of infection and multiorgan failure after 148 months. The mortality rates led to an overall actuarial survival of 88.9% ± 10.4% at 1 year, 77.8% ± 13.6% at 5 years, and 64.8% ± 16.5% at 10 years. Seven patients lived beyond 5 years, 4 beyond 10 years, and the patient who has longest survival is patient no. 1, with 17 years of follow-up. One patient lost kidney function after 113 months. Conclusions: In selected patients, with coexisting end-stage cardiac and renal failure, combined heart-kidney transplantation with allograft from the same donor proved to have satisfactory short- and long-term results, with a low incidence of both cardiac and renal allograft rejection.

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