Combined heart and kidney transplantation using the same donor.

A 45-year-old man received a combined heart and kidney transplant provided by the same donor. The patient was in the terminal stage of renal failure and was submitted to 3 sessions of haemodialysis per week for 2 years before transplantation. A dilated cardiomyopathy with severe impairment of left ventricular (LV) function was discovered, precluding renal transplantation alone. In the postoperative course, a cardiac rejection episode was detected by echocardiography and documented by endomyocardial biopsy; no simultaneous rejection of the kidney could be detected. The patient was discharged after 2 months, and he resumed a normal and active life. The specific problems raised by the management of such multi-organ transplantation are briefly reviewed.