An overview of combined heart and kidney transplantation.

This review describes to date the experience with combined heart-kidney transplant (HNTx) from a single donor. HNTxs are very uncommon relative to single-organ transplants of the heart and kidney, as well as combined kidney-pancreas and combined kidney-liver transplants. Two groups of patients seem to be candidates for HNTx: 1) those with end-stage heart disease and fixed (nonreversible) renal disease, and 2) those with end-stage renal disease and severe cardiac disease unamenable to other treatment. In both groups, significant disease should be limited to the heart and kidney. Reports to date generally suggest decreased cardiac rejection in HNTx relative to heart-only transplants. Renal rejection in HNTx seems markedly reduced relative to kidney-only transplants. Simultaneous rejection of both organs is very uncommon, and, therefore, surveillance of both organs is necessary. Short-term patient survival seems to be acceptable in HNTx. Long-term patient and graft survival remains unknown, and further multi-center reports are needed.