Hsu Ron-Bin, Tsai Meng-Kun, Lee Po-Huang, Lee Chii-Ming, Chen Ming-Fong, Wang Shoei-Shen, Lin Fang-Yue, Chu Shu-Hsun
Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC.
Eur J Cardiothorac Surg. 2008 Dec;34(6):1179-84. doi: 10.1016/j.ejcts.2008.08.018. Epub 2008 Oct 1.
There are no guidelines to establish the indications and contraindications for a simultaneous heart and kidney transplantation. We report our single-institutional experience with simultaneous heart and kidney transplantation.
Retrospective chart review.
Between 1995 and 2006, 13 patients with co-existing end-stage heart and renal failure underwent simultaneous heart and kidney transplantation at the authors' hospital. Heart failure was secondary to dilated cardiomyopathy in five patients, ischemic cardiomyopathy in three, cardiac allograft vasculopathy in two, and congenital heart disease, cardiac allograft failure, and acute myocarditis each in one. Renal failure was secondary to glomerulonephritis in six patients, heart failure in two, cyclosporine nephropathy in three, hypertension in one, and systemic lupus erythematosus in one. Eight patients were in UNOS status IA and five patients in UNOS status II before transplantation. The 30-day mortality rate and in-hospital mortality rate were 15% and 38%. Of eight patients in UNOS status IA, seven patients have lived beyond 30 days and three (38%) beyond 1 year. Of five patients in UNOS status II, four patients have lived beyond 30 days and four (80%) beyond 1 year. Patients in UNOS status IA had high rates of previous cardiac surgery, cardiac allograft rejection, and major renal allograft complications.
Although simultaneous heart and kidney transplantation continues to be a viable option for patients with co-existing end-stage heart and renal failure, the results do not match those of isolated heart transplantation. The clinical outcomes were not satisfactory in UNOS status IA patients with previous cardiac surgery.
目前尚无关于同期心脏和肾脏移植适应证及禁忌证的指南。我们报告我们单中心同期心脏和肾脏移植的经验。
回顾性病历审查。
1995年至2006年期间，13例终末期心脏和肾衰竭并存的患者在作者所在医院接受了同期心脏和肾脏移植。心力衰竭继发于扩张型心肌病5例、缺血性心肌病3例、心脏移植血管病变2例、先天性心脏病、心脏移植失败和急性心肌炎各1例。肾衰竭继发于肾小球肾炎6例、心力衰竭2例、环孢素肾病3例、高血压1例、系统性红斑狼疮1例。8例患者移植前处于器官共享联合网络（UNOS）IA状态，5例处于UNOS II状态。30天死亡率和住院死亡率分别为15%和38%。在8例UNOS IA状态的患者中，7例存活超过30天，3例（38%）存活超过1年。在5例UNOS II状态的患者中，4例存活超过30天，4例（80%）存活超过1年。UNOS IA状态的患者既往心脏手术、心脏移植排斥反应和主要肾脏移植并发症的发生率较高。
尽管同期心脏和肾脏移植仍然是终末期心脏和肾衰竭并存患者的一个可行选择，但结果不如单纯心脏移植。既往有心脏手术史的UNOS IA状态患者的临床结局并不理想。
