Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ BACKGROUND ++ It is postulated that heart–kidney transplantation (HKTx) can overcome the survival disadvantage of heart-alone transplant in the setting of renal dysfunction (estimated glomerular filtration rate [GFR] <60 mL/min per 1.74 m2).1 HKTx candidates on the wait list had a greater incidence of death and a lower incidence of transplantation than heart-alone candidates.2 Three-month mortality among wait list candidates1,2 21% for HKTx candidates on dialysis 7% for HKTx candidates with renal insufficiency not on dialysis 31% for heart-alone transplant candidates on dialysis 12% for heart-alone transplant candidates with renal insufficiency not on dialysis HKTx constitute 1.5% of all heart transplants 0.4% of all deceased donor kidney transplants +++ INDICATIONS ++ Severe heart failure and advanced renal insufficiency1 Candidates with renal dysfunction who are not yet on dialysis should be evaluated for the possibility of renal recovery Heart-alone recipients who are listed for a kidney transplant have almost twice the hazard of wait list death than candidates with no prior history of heart transplantation. Performing a deceased donor heart transplant simultaneously with (or preceding a) live donor kidney transplant has not been fully evaluated. +++ TECHNIQUE ++ The heart is implanted first. Recipients are then hemodynamically stabilized in the operating room or intensive care unit prior to kidney transplantation. The kidney is implanted: Immediately after the heart (if the recipient is stable) In a delayed fashion (hours after the heart if further stabilization is required) The kidney is kept on a pump or on cold storage A backup kidney transplant recipient should be identified in instances where the heart transplant recipient is not considered stable enough to tolerate the additional kidney transplant. +++ OUTCOMES ++ HKTx recipients had a better survival than heart-alone recipients with renal dysfunction.1 Five-year survival:2 73% for HKTx recipients who were on dialysis 80% for HKTx recipients who had renal insufficiency but were not on dialysis 51% for heart-alone transplant recipients on dialysis 69% for heart-alone transplant recipients with renal insufficiency but were not on dialysis No difference in 15-year survival rates after HKTx among recipients:1 ≥60 or <60 years of age On dialysis or preemptive (note: patients on dialysis were younger) Panel Reactive Antibody (PRA) status did not seem to affect 5-year survival.1 Pretransplant dialysis was not reported to influence delayed kidney function after HKTx.1 Eighty percent incidence of freedom from rejection at 5 years. Induction therapy with antithymocyte globulin may provide a survival advantage.1 Predictors of mortality after HKTx included2 Body mass index (BMI) >35 kg/m2 Preoperative need of mechanical life support Serum bilirubin >2.0 mg/dL Donor–recipient gender match was associated with improved survival.2 Forty-four percent lower adjusted relative risk of death with HKTx than with heart-alone transplant.3 Approximately 60% of HKTx performed involved recipients not yet on dialysis.3 Four-year ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth