Bruschi G, Botta L, Colombo T, Busnach G, Pedrazzini G, Cannata A, Trunfio S, Macera F, Turazza F, Oliva F, Sansalone C V, Paino R, Frigerio M, Martinelli L
Cardiology & Cardiac Surgery Department A De Gasperis, Niguarda Ca' Granda Hospital, Milan, Italy.
Transplant Proc. 2010 May;42(4):1283-5. doi: 10.1016/j.transproceed.2010.03.064.
Combined heart-kidney transplantation (HKTx) is an accepted therapeutic option for patients with end-stage heart disease associated with severely impaired renal function. We report our long-term follow-up with this combined procedure.
Between April 1989 to November 2009, nine patients underwent combined simultaneous (HKTx) at our center. Seven patients were males (mean age 45.2 +/- 10.12 years); seven patients were on dialysis at the time of transplantation.
Surgical procedures were uneventful in all patients. One patient died in the intensive care unit 41 days after transplantation. During long-term follow-up, three patients died: one due to infection and multiorgan failure 148 months after HKTx, one due to a lung neoplasm after 6 years, and one, a cerebral stroke at 34 months after transplantation. Only one patient experience renal allograft failure secondary to hypertension and cyclosporine nephrotoxicity at 10 years after HKTx with the need for renal replacement therapy. Last estimated glomerular filtration rates of all other patients was 61.3 +/- 17.4 mL/min.
In selected patients, with coexisting end-stage cardiac and renal failure, combined HKTx with an allograft from the same donor proved to give satisfactory short- and long-term results, with a low incidence of both cardiac and renal allograft complications.
心肾联合移植（HKTx）是终末期心脏病合并严重肾功能损害患者可接受的治疗选择。我们报告了我们对该联合手术的长期随访情况。
1989年4月至2009年11月期间，9例患者在我们中心接受了同期心肾联合移植（HKTx）。7例为男性（平均年龄45.2±10.12岁）；7例患者在移植时正在接受透析治疗。
所有患者手术过程均顺利。1例患者在移植后41天死于重症监护病房。在长期随访期间，3例患者死亡：1例在HKTx后148个月因感染和多器官功能衰竭死亡，1例在6年后因肺部肿瘤死亡，1例在移植后34个月因脑卒中死亡。仅1例患者在HKTx后10年因高血压和环孢素肾毒性继发肾移植失败，需要进行肾脏替代治疗。所有其他患者最后一次估计的肾小球滤过率为61.3±17.4 mL/分钟。
对于终末期心脏和肾衰竭并存的特定患者，采用来自同一供体的移植物进行心肾联合移植（HKTx），短期和长期结果均令人满意，心脏和肾移植并发症的发生率均较低。
