Overcoming challenges in patient selection and monitoring in combined heart and kidney transplantation.
Journal
Current opinion in organ transplantation
ISSN: 1531-7013
Titre abrégé: Curr Opin Organ Transplant
Pays: United States
ID NLM: 9717388
Informations de publication
Date de publication:
01 08 2022
01 08 2022
Historique:
entrez:
10
11
2022
pubmed:
11
11
2022
medline:
15
11
2022
Statut:
ppublish
Résumé
Combined heart-kidney transplantation (HKT) is a growing therapeutic strategy in patients with advanced heart failure (HF) and concomitant chronic kidney disease (CKD). Although patients with advanced HF and need for chronic haemodialysis have a clear indication for combined HKT, challenges to current practice lie in identifying those patients with severely depressed kidney function, which will not recover kidney function after restoration of appropriate haemodynamic conditions following heart transplantation (HT) alone. Because of the paucity of available organs, maximisation of kidney graft utility whilst minimising the operative risks associated with combined transplantation is mandatory. The benefits of HKT go beyond the mere restoration of kidney function. Data from registry analysis show that HKT improves overall survival in patients with CKD, as compared to heart transplant only, and it is associated with reduced incidence of heart allograft rejection, likely through the promotion of host immune tolerance mechanisms. In patients not requiring chronic dialysis, kidney-after-heart strategy may be explored, instead of combined HKT, in particular when the aetiology of CKD is unclear. This indeed allows for monitoring and gaging of indications for combined transplantation in the postoperative period. This approach however should be matched with priority listing for kidney transplantation given the high waitlist mortality in heart transplant recipients with associated CKD. The use of kidney machine perfusion may represent an additional tool to optimise the outcome of HKT, allowing more time to stabilise the patient after HT surgery.
Identifiants
pubmed: 36354263
doi: 10.1097/MOT.0000000000000989
pii: 00075200-202208000-00018
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
363-368Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Références
Rangaswami J, Bhalla V, Blair JEA, et al. Cardiorenal syndrome: classification, pathophysiology, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation 2019; 139:e840–e878.
Braam B, Joles JA, Danishwar AH, Gaillard CA. Cardiorenal syndrome - current understanding and future perspectives. Nat Rev Nephrol 2014; 10:48–55.
Kobashigawa J, Dadhania DM, Farr M, et al. Consensus conference on heart-kidney transplantation. Am J Transplant 2021; 21:2459–2467.
Miklin DJ, Mendoza M, DePasquale EC. Two is better than one: when to consider multiorgan transplant. Curr Opin Organ Transplant 2022; 27:86–91.
Khush KK, Hsich E, Potena L, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: thirty-eighth adult heart transplantation report – 2021; focus on recipient characteristics. J Heart Lung Transplant 2021; 40:1035–1049.
Kumar A, Bonnell LN. Thomas CP: Impact of changing renal function, while waiting for a heart transplant, on posttransplant mortality and development of end stage kidney disease. Transpl Int 2021; 34:1044–1051.
Jeon J, Park H, Kim Y, et al. Prognostic factors of renal outcomes after heart transplantation: a nationwide retrospective study. J Clin Med 2021; 10:5110.
Jeon J, Kwon HJ, Yoo H, et al. Clinical factors associated with renal outcome after heart transplantation. Int Heart J 2021; 62:850–857.
Kolsrud O, Karason K, Holmberg E, et al. Renal function and outcome after heart transplantation. J Thorac Cardiovasc Surg 2018; 155:1593–1604.
Schaffer JM, Chiu P, Singh SK, et al. Heart and combined heart-kidney transplantation in patients with concomitant renal insufficiency and end-stage heart failure. Am J Transplant 2014; 14:384–396.
Agarwal KA, Patel H, Agrawal N, et al. Cardiac outcomes in isolated heart and simultaneous kidney and heart transplants in the United States. Kidney Int Rep 2021; 6:2348–2357.
Karamlou T, Welke KF, McMullan DM, et al. Combined heart-kidney transplant improves posttransplant survival compared with isolated heart transplant in recipients with reduced glomerular filtration rate: Analysis of 593 combined heart-kidney transplants from the United Network Organ Sharing Database. J Thorac Cardiovasc Surg 2014; 147:456–461.
Awad MA, Czer LSC, Emerson D, et al. Combined heart and kidney transplantation: clinical experience in 100 consecutive patients. J Am Heart Assoc 2019; 8:e010570.
Uchino S, Bellomo R, Goldsmith D. The meaning of the blood urea nitrogen/creatinine ratio in acute kidney injury. Clin Kidney J 2012; 5:187–191.
Beetz O, Thies J, Weigle CA, et al. Simultaneous heart-kidney transplantation results in respectable long-term outcome but a high rate of early kidney graft loss in high-risk recipients - a European single center analysis. BMC Nephrol 2021; 22:258.
Pravisani R, Guzzi G, Baccarani U, et al. Machine perfusion use for combined staged kidney transplantation after heart re-transplantation: keep calm and stabilize the recipient!. Transpl Int 2020; 33:1154–1156.
Ekser B, Mangus RS, Fridell W, et al. A novel approach in combined liver and kidney transplantation with long-term outcomes. Ann Surg 2017; 265:1000–1008.
Gaffey AC, Chen CW, Chung J, et al. Bridge with a left ventricular assist device to a simultaneous heart and kidney transplant: Review of the United Network for Organ Sharing database. J Card Surg 2017; 32:209–214.
Melvinsdottir I, Foley DP, Hess T, et al. Heart and kidney transplant: should they be combined or subsequent? ESC Heart Fail 2020; 5:2734–2743.
Dec GW, Narula J. Toward immunomodulation in heart transplantation: 2 organs are better than 1. J Am Coll Cardiol 2021; 77:1341–1343.
Raichlin E, Daly RC, Rosen CB, et al. Combined heart and liver transplantation: a single-center experience. Transpl Int 2015; 28:828–834.
Narula J, Bennett LE, DiSalvo T, et al. Outcomes in recipients of combined heart-kidney transplantation: multiorgan, same-donor transplant study of the International Society of Heart and Lung Transplantation/United Network for Organ Sharing Scientific Registry. Transplantation 1997; 63:861–867.
Chou AS, Habertheuer A, Chin AL, et al. Heart-kidney and heart-liver transplantation provide immunoprotection to the cardiac allograft. Ann Thorac Surg 2019; 108:458–466.
Gill J, Shah T, Hristea I, et al. Bunnapradist S: outcomes of simultaneous heart–kidney transplant in the US: a retrospective analysis using OPTN/UNOS Data. Am J Transplant 2009; 9:844–852.
Organ Procurement and Transplantation Network. Ethical principles in the allocation of human organs. U.S. Department of Health & Human Services, 2015. Retrieved February 6, 2022, from https://optn.transplant.hrsa.gov/professionals/by-topic/ethical-considerations/ethical-principles-in-the-allocation-of-human organs/#:∼:text=Utility%2C%20justice%2C%20and%20respect%20for,of%20scarce%20organs%20for%20transplantation.
Centro Nazionale Trapianti. Report Annuale 2019 del Sistema Informativo Trapianti. Ministero Della Salute, 2019. Retrieved February 6, 2022, from https://www.trapianti.salute.gov.it/imgs/C_17_cntPubblicazioni_364_allegato.pdf