Combined heart-kidney transplantation: initial experience at a university hospital

Abstract

Introduction: Renal failure before heart transplantation is a post-transplantation morbimortality factor. Nowadays, combined heart-kidney transplantation in heart transplant candidates with associated kidney disease is a therapeutic option. Objectives: To compare the outcomes of heart-kidney transplant (HKTx) recipients and isolated heart transplant (HTx) recipients without renal impact. Patients and methods: Between 2006 and 2012, 161 adult recipients underwent HTx at the Favaloro Foundation University Hospital. Since 2006, heart transplant candidates associated to a Creatinine Clearance < 40 ml/min or requiring dialysis were considered eligible for combined heart -kidney transplant at our centre. Eighteen patients (9%) received a HKTx and 143 received isolated HTx. A comparison between HKTx and HTx recipients' variables was performed by t test or chi square test. The survival of HKTx recipients was analyzed using the Kaplan Meier method and compared to HTx recipients by long-rank test. Results: Mean age of HKTx and HTx recipients were 58±8 vs 49±13 years (p=0.01); and 15 (83%) vs 110 (77%) (p=NS) were men respectively. Seven out of 18 HKTx recipients were undergoing dialysis previous to the transplant. The pre-transplant serum Cr was higher and Cr Clearance was lower in HKTx recipients: 3.4±2.5vs1.1±0.4mg/dl (p<0.001) and 37±23vs85±44 ml/min (p<0.001). The incidence of primary cardiac allograft failure (HKTx vs HTx) was 4 (22%) vs. 29 (20%), and 4 patients presented delayed renal graft function after transplantation n hospital mortality rate was similar in both groups (HKTx vs HTx): 22% vs 15% (p=NS). Serum Cr at 1 month of follow-up was 1.1 ±0.3 vs 1.1 ±0.4 mg/dl (p=NS) During the period analyzed, 24-month follow-up median (7-41), 1-year survival was 72% vs 79% (p=0.9). Conclusion: Combined heart-kidney transplantation in patients with renal failure ensured post-transplant stable renal function and a similar survival rate to those patients with heart transplantation without kidney disease.