Abstract 4046: Long-term Survival After Combined Heart and Kidney Transplantation is Comparable to Heart Transplantation Alone
Patients with advanced heart failure and co-existing renal failure present a formidable challenge. The role of combined solid organ transplantation in this setting remains to be determined. We reviewed the experience with combined heart-kidney transplantation (H-KTx) in comparison with heart transplant (HTx) alone at our institution.
Methods: Medical records of patients undergoing heart (HTx) or combined heart-kidney (H-KTx) transplantation between June 1992 and March 2009 were reviewed. Baseline characteristics, peri-operative factors, survival rates, and rejection frequency after H-KTx were compared in patients having HTx alone during the same time period.
Results: There were 30 patients who underwent H-KTx and 440 had HTx alone. The two groups were similar in age, gender, etiology of heart disease, functional class, left ventricular ejection fraction, end-diastolic diameter, cardiac output, and waitlist status. Patients with H-KTx had a higher serum creatinine (p<0.001) and a trend toward a greater incidence of hypertension (p<0.07). There were no differences in cardiac allograft ischemic times, cardiopulmonary bypass, or cross-clamp times. A staged procedure (return to ICU between heart and kidney transplant) was performed in 21 of the 30 H-KTx patients. Mean (±SD) kidney allograft ischemic time was 14.6±9 hours (range, 4 – 49 hrs). Kaplan-Meier survival estimates were similar in the H-KTx and HTx alone groups (mean %±S.E.) at 30 days (93±4.6 and 98±0.7), one year (90±5.5 and 94±1.2), five years (70±9.7 and 76±2.2), and ten years (50±12 and 51±3.1) (p=0.82). The serum creatinine (mean±SD) after H-KTx was 1.6±1.8 at 30 days, 1.4±0.7 at one year, and 1.6±1.2 at 5 years.
Conclusions: Combined heart and kidney transplantation offers excellent survival which is similar to HTx alone. Patients presenting with advanced heart failure and poor renal function can be routinely considered for combined heart and kidney transplantation.