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J Thorac Cardiovasc Surg 2003;126:2065-2071
© 2003 The American Association for Thoracic Surgery

Cardiothoracic transplantation

Ten-year follow-up in patients with combined heart and kidney transplantation

^a Cardiothoracic Surgery, Emory University, Atlanta, Ga, USA
^b Cardiology, Emory University, Atlanta, Ga, USA
^c Kidney Transplantation, Emory University, Atlanta, Ga, USA

Received for publication November 7, 2002; revisions received July 27, 2003; accepted for publication July 30, 2003.

^* Address for reprints: Gregory D. Trachiotis, MD, The Division of Cardiovascular and Thoracic Surgery, Sec 112, The George Washington University Medical Center/Veterans Affairs Medical Center, 50 Irving St, NW, Washington, DC 20422, USA
gtrachiotis{at}mfa.gwu.edu

BACKGROUND: Combined heart and kidney transplantation has been documented, although data regarding immunosuppression, rejection episodes, and graft or patient survival have not been detailed. We evaluated our experience and more than 10-year outcome with patients selected for combined heart and kidney transplantation.

METHODS: Eight patients aged 29 to 59 years were selected for combined heart and kidney transplantation. The indications were end-stage heart disease and underlying renal pathology, or secondary renal insufficiency, or renal failure. Six patients were dialysis dependent before transplantation. There were 7 simultaneous procedures and 1 staged procedure. The heart was transplanted first in all cases. All patients were maintained after transplantation on azathioprine (2 mg · kg^-1 · d^-1) and whole-blood monoclonal cyclosporine levels at greater than 200 µg/L; prednisone was not decreased to less than 10 mg/d.

RESULTS: Seven (87.5%) patients have survived a mean duration of 100.4 months (range, 51-144 months), and each allograft has continued to function. The only death was due to pulmonary emboli and was not related to allograft rejection or failure. Only 4 cardiac and 4 kidney allograft rejections have occurred. Five patients have been free of kidney rejection, 1 patient has been rejection free for more than 8 years, and no patient has had simultaneous rejection.

CONCLUSIONS: In select patients, combined heart and kidney transplantation can provide long-term graft function and patient survival. The low rates of rejection support our current approach to immunosuppression. Our experience indicates that end-stage failure of either heart or kidney does not necessarily preclude dual-organ transplantation.

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