Blanche C, Kamlot A, Blanche D A, Kearney B, Wong A V, Czer L S, Trento A
Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif 90048, USA.
J Thorac Cardiovasc Surg. 2001 Sep;122(3):495-500. doi: 10.1067/mtc.2001.115700.
Combined heart-kidney transplantation with allografts from the same donor has been long proved to be a feasible approach for selected patients with coexisting end-stage cardiomyopathy and renal disease. The purpose of this retrospective study is to analyze our long-term results and compare these results with heart-only transplantation over a 7-year period.
Between June 1992 and April 1999, 10 patients underwent combined heart-kidney transplantation at Cedars-Sinai Medical Center. They were all men from 44 to 70 years old (mean age, 59 +/- 8.3 years) who had a mean left ventricular ejection fraction of 19.4% +/- 5.0% (range, 9%-25%) and a mean creatinine clearance of 25.4 mL/min (range, 10-39 mL/min). Four patients underwent pretransplantation dialysis.
There was no operative mortality. The actuarial survival at 1, 2, and 5 years was 100%, 88% +/- 11.7%, and 55% +/- 20.1%, respectively. By comparison, the operative mortality of 169 patients who underwent heart-only transplantation during the same time interval was 2.4%, with an actuarial survival at 1, 2, and 5 years of 92% +/- 2.1%, 84% +/- 2.8%, and 71% +/- 3.9%, respectively (P =.37). Eight patients showed no evidence of significant (> or =1B) cardiac allograft rejection postoperatively, and the actuarial freedom from rejection at 30 days, 1 year, and 2 years was 90% +/- 9%, 80% +/- 13%, and 80% +/- 13%, respectively. Renal allograft survival was 90% at 1 and 2 years.
Combined heart-kidney transplantation yields satisfactory long-term results similar to those for heart-only transplantation, with a low incidence of cardiac allograft rejection and renal allograft survival when both allografts are from the same donor. This approach effectively expands the selection criteria for heart-only and kidney-only transplantation in potential candidates with coexisting end-stage cardiac and renal disease.
长期以来，对于患有终末期心肌病和肾病的特定患者，采用来自同一供体的心脏-肾脏联合移植已被证明是一种可行的方法。这项回顾性研究的目的是分析我们的长期结果，并将这些结果与7年期间单纯心脏移植的结果进行比较。
1992年6月至1999年4月期间，10例患者在雪松西奈医疗中心接受了心脏-肾脏联合移植。他们均为44至70岁的男性（平均年龄59±8.3岁），左心室射血分数平均为19.4%±5.0%（范围9%-25%），肌酐清除率平均为25.4 mL/分钟（范围10-39 mL/分钟）。4例患者在移植前接受了透析。
无手术死亡。1年、2年和5年的精算生存率分别为100%、88%±11.7%和55%±20.1%。相比之下，同期接受单纯心脏移植的169例患者的手术死亡率为2.4%，1年、2年和5年的精算生存率分别为92%±2.1%、84%±2.8%和71%±3.9%（P=0.37）。8例患者术后未出现明显（≥1B级）心脏移植排斥反应的证据，30天、1年和2年无排斥反应的精算自由度分别为90%±9%、80%±13%和80%±13%。肾移植1年和2年的生存率为90%。
心脏-肾脏联合移植产生了与单纯心脏移植相似的令人满意的长期结果，当两个移植器官均来自同一供体时，心脏移植排斥反应发生率低且肾移植生存率高。这种方法有效地扩大了患有终末期心脏和肾脏疾病的潜在候选者单纯心脏移植和单纯肾脏移植的选择标准。
