Guidelines Suggested for Heart-Kidney Transplants
WEDNESDAY March 18, 2009 -- A set of criteria to help identify people who would benefit from a combined heart and kidney transplant has been developed by U.S. researchers.
"In the past, patients with end-stage heart failure having concurrent renal (kidney) disease were not considered candidates for heart transplantation," Dr. Mark J. Russo, of Columbia University Medical Center/New York Presbyterian Hospital, and colleagues noted in the study. "With advances in operative techniques and perioperative (around the time of surgery) management, combined heart and kidney transplantation is offered to select patients in this population."
However, there are no standardized guidelines for heart and kidney transplants.
The researchers analyzed data from 274 people who had combined heart and kidney transplants between 1995 and 2005. Pre-transplant factors that reduced survival were: peripheral vascular disease (disease of blood vessels outside the heart and brain); being older than 65; heart failure that was non-ischemic, meaning it was not caused by blocked or narrowed arteries; and dependence on dialysis or a pumping device that assists the heart as a bridge to transplantation.
When people were grouped according to these risk factors, the one-year survival rate was about 93 percent for those in the lowest-risk group and 62 percent for those with the greatest risk.
About a fourth of the highest-risk patients died from infection. The study found that people older than 65, those with peripheral artery disease and those bridged to transplantation with a pumping-assist device appeared more vulnerable to infection, which explained their increased risk of death. But it was not clear why people with non-ischemic heart failure also had a high risk of death, the researchers said.
"Among patients with combined kidney failure (estimated glomerular filtration rate less than 33 milliliters per minute) and heart failure, those classified by this risk stratification scheme as low-risk should undergo combined heart and kidney transplantation, while there is no demonstrable benefit for combined heart and kidney transplantation over heart transplantation alone in patients classified as high risk," they concluded.
The study is in the March issue of Archives of Surgery.
The National Kidney Foundation has more about kidney transplantation.
Posted: March 2009