Use of ventricular assist device as bridge to simultaneous heart and kidney transplantation in patients with cardiac and renal failure
Autor: | A. Ruzza, Ernst R. Schwarz, Alfredo Trento, Lawrence S.C. Czer, Sinan Simsir, R. Yanagida, Stanley C. Jordan |
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Rok vydání: | 2013 |
Předmět: |
Adult
Male medicine.medical_specialty Time Factors Waiting Lists medicine.medical_treatment Biopsy chemistry.chemical_compound Renal Dialysis Internal medicine medicine Humans Ventricular Function Renal Insufficiency Kidney transplantation Retrospective Studies Heart Failure Transplantation Creatinine Ejection fraction Cardio-Renal Syndrome business.industry Immunosuppression Middle Aged medicine.disease Kidney Transplantation Survival Analysis Surgery Treatment Outcome chemistry Heart failure Ventricular assist device Cardiology Heart Transplantation Drug Therapy Combination Female Hemodialysis Heart-Assist Devices business Biomarkers Immunosuppressive Agents |
Zdroj: | Transplantation proceedings. 45(6) |
ISSN: | 1873-2623 |
Popis: | Background Ventricular assist device (VAD) implantation as a bridge to cardiac transplantation is an effective treatment option for end-stage heart failure. Renal dysfunction is not uncommon but is considered to be a poor prognostic factor. We present our experience with 6 patients who had combined heart and kidney transplantation (HKT) after VAD implantation for advanced cardiac and renal failure. Methods Of 74 patients who underwent VAD implantation as a bridge to transplant from May 2001 to September 2009, 28 patients developed renal failure, and of these, 6 (5 male, 1 female, ages 40–64 years) had HKT. All required hemodialysis because of renal failure before HKT. Immunosuppression consisted of anti-thymocyte globulin followed by triple drug therapy consisting of calcineurin inhibitors, mycophenolate, and corticosteroids. Results Of the 6 HKT patients, 5 (83%) were alive without hemodialysis at 1 and 2 years; of the 22 patients with renal failure after VAD implantation without subsequent transplant, 1- and 2-year survivals were zero. Interval from VAD implantation to HKT ranged from 36 to 366 days (133 ± 127 days). At 6 months after HKT (100% alive), left ventricular ejection fraction was 60.2 ± 5.8% and serum creatinine 1.1 ± 0.2 mg/dL. Three HKT patients required temporary hemodialysis after surgery. Endomyocardial biopsy showed absence of ISHLT grade 2R-3A or greater cellular rejection, and none showed evidence of definite antibody-mediated rejection. Conclusions Based on our initial experience, simultaneous HKT is a safe treatment option with excellent outcomes for patients with advanced heart failure and persistent renal dysfunction after VAD implantation. |
Databáze: | OpenAIRE |
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