Kidney Transplantation Combined With Other Organs in Bologna: An Update

Background: We retrospectively reviewed our experience in combined liver-kidney (L-KT) and heart-kidney (H-KT) transplantations. Patients and Methods: Between January 1997 and April 2007, we performed 25 L-KT and 5 H-KT. Patient mean age was 51 ± 8 years in L-KT and 43 ± 11 years in H-KT. The main cause of liver failure was chronic viral hepatitis (14 cases). Etiology of heart failure was dilated cardiomyopathy and hypertrophic cardiomyopathy (4 and 1 patients, respectively). The main causes of renal failure in L-KT were chronic glomerulonephritis (n = 8) and polycystic disease (n = 7). Etiology of renal failure in H-KT was interstitial nephropathy (n = 2), vascular nephropathy (n = 2), and chronic glomerulonephritis (n = 1). Results: Mean follow-up was 32 ± 26 months in L-KT and 24 ± 17 months in H-KT. Immunosuppression was cyclosporine-based (n = 4) or tacrolimus-based (n = 21) in L-KT and cyclosporine-based in H-KT. Acute rejection rate was 8% for both liver and kidney in L-KT; 80% (mild) for heart and 40% for kidney in H-KT. In the L-KT group, there was no primary graft nonfunction (PGNF). Two patients experienced liver delayed graft function (DGF); 1 patient required postoperative dialysis. One-year graft and patient survivals were both 84% and overall graft and patient survival was 76%. In the H-KT group, 3 patients needed postoperative dialysis and 1 required a cardiac assistance device for 48 hours; overall graft and patient survival was 100% with good cardiac and renal functions. Conclusion: Our experience confirmed that H-KT and L-KT are safe procedures, offering good long-term results.