Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC.
Eur J Cardiothorac Surg. 2010 Jan;37(1):68-73. doi: 10.1016/j.ejcts.2009.06.006. Epub 2009 Jul 24.
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.
Retrospective case review.
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.
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.
对于肾功能障碍的患者，目前尚无指南指导选择单纯心脏移植或心脏-肾脏同期移植。本研究旨在评估同期肾脏移植对肾功能障碍患者心脏移植结局的影响。
回顾性病例分析。
1993 年至 2006 年，45 例术前血清肌酐>or=2 mg/dl(-1)的患者接受了心脏移植，其中 32 例为单纯心脏移植，13 例为心脏-肾脏同期移植。同期心脏-肾脏移植患者术后 30 天、1 年和 3 年的存活率分别为 83.3+/-10.8%、58.3+/-14.2%和 50.0+/-14.4%，与单纯心脏移植患者术后 30 天、1 年和 3 年的存活率 81.8+/-6.7%、66.7+/-8.2%和 45.1+/-9.3%相比，差异均无统计学意义。同期心脏-肾脏移植患者术后 30 天、1 年和 3 年的无透析存活率和患者存活率分别为 66.7+/-13.6%、58.3+/-14.2%和 50.0+/-14.4%，与单纯心脏移植患者术后 30 天、1 年和 3 年的无透析存活率和患者存活率分别为 81.8+/-6.7%、66.7+/-8.2%和 31.4+/-8.9%相比，差异均无统计学意义。
对于术前依赖透析的患者，同期肾脏移植是一种有效的治疗方法，可将这些非常虚弱患者的术后死亡率风险降低至无需透析的、病情较轻的移植前患者的水平。
