Effect of simultaneous kidney transplantation on heart-transplantation outcome in recipients with preoperative renal dysfunction.

OBJECTIVE

There are no guidelines to select isolated heart transplantation or simultaneous heart and kidney transplantation in patients with renal dysfunction. We sought to assess the effect of simultaneous kidney transplantation on heart-transplantation outcome in patients with renal dysfunction.

METHODS

Retrospective case review.

RESULTS

Between 1993 and 2006, 45 patients with preoperative serum creatinine >or=2 mg dl(-1) underwent heart transplantation, including 32 isolated heart transplantation and 13 simultaneous heart and kidney transplantation. The survival of 83.3+/-10.8% at 30 days, 58.3+/-14.2% at 1 year and 50.0+/-14.4% at 3 years in simultaneous heart and kidney transplantation did not differ from the survival of 81.8+/-6.7% at 30 days, 66.7+/-8.2% at 1 year and 45.1+/-9.3% at 3 years in isolated heart transplantation. The dialysis-free and patient survival of 66.7+/-13.6% at 30 days, 58.3+/-14.2% at 1 year and 50.0+/-14.4% at 3 years in simultaneous heart and kidney transplantation also did not differ from the rate of 81.8+/-6.7% at 30 days, 66.7+/-8.2% at 1 year and 31.4+/-8.9% at 3 years in isolated heart transplantation.

CONCLUSIONS

Simultaneous kidney transplantation is an effective therapy for patients depending on dialysis pretransplant, reducing postoperative risk of mortality in these very sick patients to the level of patients with less severe renal disease not requiring dialysis before transplant.