Journal of Heart and Cardiology
A 25 year Review of Combined Cardiac and Renal Transplant Outcomes in Patients with End Stage Cardiac Failure on Renal Replacement Therapy. A Single Center Experience.
- 1Department of Cardiology, Heart Failure and Transplant St Vincent’s Hospital, Sydney, New South Wales, Australia
- 2Department of Cardiac and Thoracic Surgery, St Vincent’s Hospital, Sydney, New South Wales, Australia/li>
- 33Department of Renal Medicine and Transplantation St Vincent’s Hospital, Sydney, New South Wales, Australia
Chris Anthony, MBBS, Department of Cardiology, Heart Failure and Transplant St Vincent’s Hospital, 1/569 George Street, Sydney-2000, New South Wales, Australia, Tel: 0061424132549; E-mail: firstname.lastname@example.org; email@example.com
Anthony, C., et al. A 25 Year Review of Combined Cardiac and Renal Transplant Outcomes in Patients with End Stage Cardiac Failure on Renal Replacement Therapy. A Single Center Experience. (2016) J Heart Cardiol 2(2): 59-67.
© 2016 Chris Anthony. This is an Open access article distributed under the terms of Creative Commons Attribution 4.0 International License.
KeywordsCombined Heart Kidney Transplant; Heart Failure; Renal Failure; Cardiorenal Syndrome
Background: Combined heart and kidney transplantation has been shown to be a viable option for patients who have concurrent end stage cardiac and renal failure. However there is limited long term survival data that compares the outcomes of patients undergoing combined heart-kidney transplantation to patients undergoing solitary cardiac transplantation. There is also limited data on patients with end stage cardiac failure who are on concurrent renal replacement therapy prior to organ transplantation and their outcomes.
This study reviews the short and long term outcomes of combined heart kidney transplantation over a 25 year period in comparison to solitary cardiac transplantation in a majority of patients undergoing renal replacement therapy at time of transplant listing.
Methods and Results: In total there were 16 patients who underwent combined heart and kidney transplantation in the period between October 1990 and June 2014 (including heart and kidney re-transplantation) with 14 patients (87.5%) on renal replacement therapy at time of combined procedure. They were listed for combined heart and kidney transplantation as they fulfilled our institution’s criteria for irreversible end-stage heart and kidney failure. Retrospective review of patient data from the transplant database, patient case notes and post-mortem reports were carried out. Statistical analysis was then performed on key patient demographics alongside actuarial survival analysis, which were then graphically annotated. IRB approval was obtained and informed consent from patients was also obtained.
The mean (SD) recipient age was 42 (13) years and there were 3 females. Dilated cardiomyopathy was the most common primary cardiac pathology (50%) whilst ischemic nephrosclerosis (25%) and glomerulonephritis (25%) were the most common primary renal pathologies. Most patients experienced NYHA class IV symptoms (62.5%). The average wait time to transplantation at our institution was 12 months.
There was no operative mortality. The cumulative 1 year survival in the combined transplant group was 0.75 with 4 out of 16 mortalities within the first year (25%). In comparison the cumulative 1 year survival of the heart only transplant group was 0.86 with 116 mortalities within the first year over a 25 year period.
Cumulative survival at 5, 10, 15 and 25 years for the combined transplant group was 0.69, 0.55, 0.437 and 0.437 respectively. In comparison cumulative survival of the heart only transplant group at the 5, 10, 15 and 25 year mark was 0.76, 0.59, 0.45 and 0.23 respectively.
The incidence of cardiac rejection episodes in the study time was 9 out of 16 (56%) versus 3/16 (19%) who had renal rejection. In the study period there was 1 death out of 7 deaths due to dual graft failure.
Conclusions: Combined sequential cardiac and renal transplantation has good short- and long-term outcomes for patients with coexisting end stage cardiac and renal failure. At the ten year mark actuarial survival for combined heart and kidney transplantation is equivalent to cardiac transplantation alone.