Groetzner Jan, Kaczmarek Ingo, Mueller Markus, Huber Stefan, Deutsch Andre, Daebritz Sabine, Arbogast Helmut, Meiser Bruno, Reichart Bruno
Department of Cardiac Surgery, Ludwig Maximilians University Hospital Grosshadern-Munich, Munich, Germany.
J Heart Lung Transplant. 2005 Nov;24(11):1787-92. doi: 10.1016/j.healun.2005.03.012.
In end-stage cardiomyopathy where concomitant chronic renal failure is a contraindication for cardiac transplantation (HTx), simultaneous heart and kidney transplantation (HKTx) may be the only feasible therapeutic option. Due to the increased donor shortage, the clinical outcome of combined HKTx patients on tacrolimus-based immunosuppression was assessed and compared with a group of HTx patients.
Three hundred forty-nine HTxs, including 13 (4%) combined HKTxs, were performed since 1995. Two hundred twenty-one HTx and all HKTx recipients received tacrolimus-based immunosuppression. Acute rejection episodes (AREs), infections, renal function and clinical outcome were evaluated. Pre-operative renal diagnoses for HKTx patients included cystic nephropathy (n = 4), glomerulonephritis (n = 4), cytostatica-induced nephropathy (n = 1), chronic rejection after renal transplant (n = 1), reflux nephropathy (n = 2) and chronic calcineurin-inhibitor -induced nephropathy after HTx (n = 1). Twelve patients (92%) were on hemodialysis pre-operatively, 1 underwent implantation of a left ventricular assist device (LVAD) before HKTx.
After 4.7 +/- 2 years, 92% of HKTx compared with 85% of HTx patients had survived (p = 0.42). Acute cardiac rejection episodes were more frequent in HTx than in HKTx patients (0.04 +/- 0.09 vs 0.02 +/- 0.04 ARE/100 patient-days; p = 0.07). Incidence of infection was comparable (0.3 +/- 0.2 vs 0.5 +/- 0.4 infection/100 patient-days). Freedom from transplant vasculopathy was 100% in the HKTx group compared with 71% in the HTx group after 4 years (p = 0.04).
Tacrolimus-based immunosuppression yields promising long-term results in HKTx and HTx. The incidence of transplant vasculopathy seems to be lower after HKTx than after HTx. If these results are secondary to a protective effect of tacrolimus-induced tolerance or of tolerance-associated co-transplantation they will need to be investigated in prospective multicenter trials.
在晚期心肌病合并慢性肾衰竭而成为心脏移植（HTx）禁忌证的情况下，同期心脏和肾脏移植（HKTx）可能是唯一可行的治疗选择。由于供体短缺加剧，对接受基于他克莫司免疫抑制治疗的HKTx联合患者的临床结局进行了评估，并与一组HTx患者进行了比较。
自1995年以来，共进行了349例HTx，其中包括13例（4%）联合HKTx。221例HTx患者和所有HKTx受者接受了基于他克莫司的免疫抑制治疗。评估了急性排斥反应（AREs）、感染、肾功能和临床结局。HKTx患者术前的肾脏诊断包括囊性肾病（n = 4）、肾小球肾炎（n = 4）、细胞毒性药物引起的肾病（n = 1）、肾移植后慢性排斥反应（n = 1）、反流性肾病（n = 2）以及HTx后慢性钙调神经磷酸酶抑制剂引起（n = 1）。12例患者（92%）术前接受血液透析，1例在HKTx前植入了左心室辅助装置（LVAD）。
4.7±2年后，HKTx患者的生存率为92%，HTx患者为85%（p = 0.42）。HTx患者的急性心脏排斥反应比HKTx患者更频繁（0.04±0.09对0.02±0.04次ARE/100患者日；p = 0.07）。感染发生率相当（0.3±0.2对0.5±0.4次感染/100患者日）。4年后，HKTx组移植血管病变的无病生存率为100%，而HTx组为71%（p = 0.04）。
基于他克莫司的免疫抑制治疗在HKTx和HTx中产生了有前景的长期结果。HKTx后移植血管病变的发生率似乎低于HTx后。如果这些结果是由于他克莫司诱导的耐受性或耐受性相关的联合移植的保护作用所致，则需要在前瞻性多中心试验中进行研究。
