Combined cardiorenal transplant in heart and advanced renal disease

• Main Authors: Margarita Peradejordi Lastras, Liliana Ethel Favaloro, Rita Marcela Fortunato, Luis Gutiérrez, Gabriel Eduardo Rabin, Daniel Oscar Absi, José Abud, Héctor Raffaelli, Rodolfo Marrugat, Hugo Fraguas, Roberto René Favaloro, Pablo Raffaele, Alejandro Mario Bertolotti
• Format: Article
• Language: Spanish
• Published: Asociación Regional de Diálisis y Trasplantes Renales de Capital Federal y Provincia de Buenos Aires 2017-04-01
• Series: Revista de Nefrología, Diálisis y Trasplante
• Subjects: trasplante cardíaco; trasplante renal; trasplante cardiorenal; trasplante combinado; insuficiencia renal
• Online Access: http://www.revistarenal.org.ar/index.php/rndt/article/view/40
• ISSN: 0326-3428; 2346-8548

Introduction: Renal failure (RF) is a post cardiac transplantation predictor of morbimortality. The combined cardiorenal transplant (CCRTx) in cardiac transplantation (CTx) candidates with chronic renal disease is a therapeutic option. Our aim was to evaluate the CCRTx follow up outcomes in a single Centre. Methods: Between 2/1993 and 12/2014 we performed 442 CTx. Since 2006, 20 patients (p) underwent CCRTx using allografts from the same donor. The inclusion criteria were: RF with CrCl ≤ 40 mil/min or dialysis requirement in CTx candidates. All p received Thymoglobulin and immunosuppression with tacrolimus, mycophenolate mofetil and steroids.Median follow up: 46 months (7-96). Results: Mean age: 58±7 years, 85% were male. Mean Creatinine (Cr): 3,1±2,5 mg/dl and ClCr 27,5+10 mil/min. Three p required dialysis during the pre-transplantation phase and 4 p were under chronic dialysis. Etiologies: cardiomyopathies: coronary 10 p, noncoronary 9 p and re CTx, 1 p; nephropathies: nephroangiosclerosis 5 p, cardiorenal syndrome 10 p, diabetes 2 p, glomerulopathy 1 p, polycystosis 1 p and toxic nephritis 1 p. At 30 days and 1 year post CCRTx, Cr was 1,2±0,4 mg/dl and 1,1±0,2 mg/dl respectively. In-hospital mortality was 3/20 p (15%), 2 p due to sepsis and 1 p due to cardiac graft failure. Late mortality 5/17 p (29 %), 4p due to sepsis and 1 p due to liver sarcoma. Survival at 1 and 3 years was 76 and 72%, respectively. Conclusions: In our series CCRTx was a safe and effective treatment for CTx candidates with CrCl < 40 ml/min.