Á López-Sainz1, E Barge-Caballero2, M J Paniagua-Martin2, R Marzoa Rivas2, G Sánchez-Fernández2, L Fernández Arias3, M García-Vieites3, Á Alonso-Hernández4, J J Rodríguez-Rivera-García5, M G Crespo-Leiro2. 1. Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain. Electronic address: kelals@hotmail.com. 2. Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain. 3. Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Servicio de Cirugía Cardiaca, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain. 4. Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Servicio de Nefrología, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain. 5. Complejo Hospitalario Universitario A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Servicio de Urología, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
Abstract
BACKGROUND: The purpose of the study was to describe clinical characteristics and long-term survival of patients undergoing combined heart-kidney transplant in a single center. METHODS: We conducted a retrospective analysis of 22 consecutive patients who underwent combined heart-kidney transplant at our institution between 1995 and 2013. Long-term outcomes were analyzed by means of the Kaplan-Meier method. RESULTS: Four patients underwent re-do transplant (2 cardiac re-transplants, 1 kidney re-transplant, and 1 combined heart-kidney re-transplant). Most frequent underlying cardiac conditions were coronary artery disease (54%), dilated cardiomyopathy (23%), and chronic rejection of a previous heart graft (18%). Known causes of chronic renal dysfunction were nephroangioesclerosis (23%), drug-related toxicity (14%), and Wegener granulomatosis (5%). Non-specified chronic renal dysfunction was present in 50% patients. In-hospital postoperative mortality rate was 5 of 22 (23%). Causes of early death were directly related to kidney transplant surgery in 4 of 5 (80%) patients. Among the remaining 17 patients who surmounted the postoperative period, long-term survival rates 1 year, 5 years, and 10 years after HKT were 88%, 82%, and 65%, respectively. Over a mean follow-up of 6.7 ± 6.4 years, cumulative incidences of cytomegalovirus infection, coronary allograft vasculopathy, malignancy, and acute cardiac graft rejection were 41%, 6%, 24%, and 41%, respectively. There was no episode of acute renal graft rejection. At the end of follow-up, all survivors (n = 11) were in functional New York Heart Association class I. Mean creatinine serum level was 1.68 mg/dL. CONCLUSIONS: In our experience, combined heart-kidney transplant is a feasible therapeutic option that yielded favorable long-term outcomes, with a low cumulative incidence of cardiac graft dysfunction. These results were obtained at the expense of a significant risk of early postoperative mortality, which was mainly related to complications of kidney transplant surgery.
BACKGROUND: The purpose of the study was to describe clinical characteristics and long-term survival of patients undergoing combined heart-kidney transplant in a single center. METHODS: We conducted a retrospective analysis of 22 consecutive patients who underwent combined heart-kidney transplant at our institution between 1995 and 2013. Long-term outcomes were analyzed by means of the Kaplan-Meier method. RESULTS: Four patients underwent re-do transplant (2 cardiac re-transplants, 1 kidney re-transplant, and 1 combined heart-kidney re-transplant). Most frequent underlying cardiac conditions were coronary artery disease (54%), dilated cardiomyopathy (23%), and chronic rejection of a previous heart graft (18%). Known causes of chronic renal dysfunction were nephroangioesclerosis (23%), drug-related toxicity (14%), and Wegener granulomatosis (5%). Non-specified chronic renal dysfunction was present in 50% patients. In-hospital postoperative mortality rate was 5 of 22 (23%). Causes of early death were directly related to kidney transplant surgery in 4 of 5 (80%) patients. Among the remaining 17 patients who surmounted the postoperative period, long-term survival rates 1 year, 5 years, and 10 years after HKT were 88%, 82%, and 65%, respectively. Over a mean follow-up of 6.7 ± 6.4 years, cumulative incidences of cytomegalovirus infection, coronary allograft vasculopathy, malignancy, and acute cardiac graft rejection were 41%, 6%, 24%, and 41%, respectively. There was no episode of acute renal graft rejection. At the end of follow-up, all survivors (n = 11) were in functional New York Heart Association class I. Mean creatinine serum level was 1.68 mg/dL. CONCLUSIONS: In our experience, combined heart-kidney transplant is a feasible therapeutic option that yielded favorable long-term outcomes, with a low cumulative incidence of cardiac graft dysfunction. These results were obtained at the expense of a significant risk of early postoperative mortality, which was mainly related to complications of kidney transplant surgery.
Authors: Feby Savira; Ruth Magaye; Danny Liew; Christopher Reid; Darren J Kelly; Andrew R Kompa; S Jeson Sangaralingham; John C Burnett; David Kaye; Bing H Wang Journal: Br J Pharmacol Date: 2020-05-13 Impact factor: 8.739
Authors: Matteo Paoletti; Barbara Cattadori; Marilena Gregorini; Alessandra Viglio; Giovanni Gentile; Andrea Maria D'Armini; Carlo Pellegrini; Alfredo La Fianza Journal: CEN Case Rep Date: 2018-01-31