Cachera J P, Benvenuti C, Deleuze P, Mazzucotelli J P, Hillion M L, Loisance D, Albo C, Abbou C, Bourgeon B, Lang P
Service de Chirurgie thoracique et cardio-vasculaire, Hôpital Henri Mondor, Créteil, France.
Bull Acad Natl Med. 1993 Jan;177(1):35-41; discussion 42.
From 1988 to 1991, five cases of combined heart and kidney transplantation using the same donor have been achieved at our institution. All patients were males, 58 +/- 6 (46 to 64). The cardiac condition leading to the cardiac replacement was a dilated cardiomyopathy in one case, end-stage ischemic disease in 3, and failure of a previous cardiac transplantation in one. The renal condition claiming for a graft was a Glomerular nephritis in one, a polycystic disease in 3, and renal failure due to CyA toxicity in one; chronic hemodialysis was mandatory in all patients but one. There were no hospital deaths. The five patients are current survivors, the mean follow-up being 22 +/- 10 months (2-50 months). Five rejection episodes occurred in three patients; two patients have never demonstrated any cardiac rejection. All but one recovered a normal renal function as soon as the 7 th post operative day; only one episode of renal rejection has been detected, easily reversed by corticoids. No simultaneity was ever observed between cardiac and renal rejection episodes. Thus, the detection of rejection must be carried out separately for each graft organ. In four patients, cineangiograms of the coronary vessels were done respectively 12, 30 and 50 months post operatively and revealed a normal coronary bed. Thus, combined heart and kidney transplantation seems to be a realistic approach in properly selected patients in whom cardiac and renal failures cannot be treated by more conventional procedures.
1988年至1991年，我院成功完成了5例使用同一供体的心脏和肾脏联合移植手术。所有患者均为男性，年龄58±6岁（46至64岁）。导致心脏置换的心脏疾病，1例为扩张型心肌病，3例为终末期缺血性疾病，1例为先前心脏移植失败。需要肾脏移植的肾脏疾病，1例为肾小球肾炎，3例为多囊肾病，1例为环孢素毒性导致的肾衰竭；除1例患者外，所有患者均需进行慢性血液透析。无医院死亡病例。5例患者均存活至今，平均随访时间为22±10个月（2至50个月）。3例患者发生了5次排斥反应；2例患者从未出现任何心脏排斥反应。除1例患者外，所有患者术后第7天肾功能即恢复正常；仅检测到1次肾脏排斥反应，经皮质类固醇治疗后容易逆转。未观察到心脏和肾脏排斥反应同时发生。因此，必须对每个移植器官分别进行排斥反应的检测。4例患者分别在术后12个月、30个月和50个月进行了冠状动脉血管造影，结果显示冠状动脉床正常。因此，对于那些无法通过更传统方法治疗心脏和肾衰竭的合适患者，心脏和肾脏联合移植似乎是一种切实可行的方法。
