Sepúlveda L, Zamorano J, Cotera A, Núñez N, Llancaqueo M, Bermúdez C, Castillo R, González M, Alvarez F
Centro Cardiovascular, Nefrología, Urología Hospital Clínico, Universidad de Chile, Santiago, Chile.
Transplant Proc. 2007 Apr;39(3):625-6. doi: 10.1016/j.transproceed.2007.02.044.
Advanced renal disease is a formal contraindication to heart transplantation, and heart failure may make a patient ineligible for kidney transplantation. The International Society of Heart and Lung Transplantation has reported 336 simultaneous heart and kidney transplantations with a 70% rate of 5 year survival. Herein we have presented the first case of simultaneous heart plus kidney transplantation in Chile. The patient is a 62-year-old man with diabetes mellitus and arterial hypertension who in 1997 had a myocardial infarction with cardiogenic shock and acute renal failure. He underwent a coronary bypass but developed progressive heart failure, with an ejection fraction less than 20% and moderate mitral regurgitation. He required chronic hemodialysis and survived a cardiac arrest, receiving an implantable cardioverter defibrillator. Transplantation was performed in 2004 in 2 phases: initially a heart, followed by a kidney transplantation. Immunosuppression included Daclizumab, cyclosporine, mycophenolate mofetil (MMF) and steroids. He developed acute renal failure but did not receive dialysis. He left the hospital at 25 days posttransplantation. Two years following double transplantation, he has not shown acute rejection episodes of either the cardiac or the kidney graft. Both cardiac and renal functions are normal. In conclusion, simultaneous heart plus kidney transplantations offer a good alternative treatment for patients with advanced disease of both organs.
晚期肾病是心脏移植的正式禁忌证，而心力衰竭可能使患者不符合肾移植条件。国际心肺移植学会报告了336例心脏和肾脏联合移植病例，5年生存率为70%。在此，我们介绍了智利首例心脏加肾脏联合移植病例。患者为一名62岁男性，患有糖尿病和动脉高血压，1997年发生心肌梗死并伴有心源性休克和急性肾衰竭。他接受了冠状动脉搭桥手术，但随后出现进行性心力衰竭，射血分数低于20%，伴有中度二尖瓣反流。他需要长期血液透析，并在心脏骤停后存活下来，植入了植入式心脏复律除颤器。2004年分两个阶段进行了移植手术：首先进行心脏移植，随后进行肾脏移植。免疫抑制方案包括达利珠单抗、环孢素、霉酚酸酯（MMF）和类固醇。他出现了急性肾衰竭，但未接受透析治疗。移植后25天出院。双器官移植两年后，他未出现心脏或肾脏移植物的急性排斥反应。心脏和肾脏功能均正常。总之，心脏加肾脏联合移植为患有这两种器官晚期疾病的患者提供了一种很好的替代治疗方法。
