By John Aiello
CONSUMER HEALTH INTERACTIVE
Most people suffering from long-standing heart failure are also likely to be plagued by reduced kidney function. The two problems tend to coexist, a result of the heart’s inability to pump an adequate amount of blood throughout the body. In addition to the suffering that someone with these conditions often endures, options for treatment tend to be limited. However, the University of California, San Francisco Medical Center (UCSF), among others, is doing dual heart-kidney transplants as a way of treating both conditions and giving the sick a second chance at life. "Previously, transplant teams believed that patients with single-organ dysfunction were the best candidates for transplantation, since only one organ needed to be replaced, while the other vital organs functioned normally," says Dr. Kiran Khush, a cardiology fellow at UCSF."However, the reality is that the functions of multiple organs are closely inter-related, so that when one organ fails, another organ is often affected.” “The initial fear was that multi-organ transplantation would have more complications, more incidences of rejection, and worse survival,” adds Khush. “But [studies] have actually shown the opposite: patients with multi-organ transplants do not have reduced survival compared to single organ transplant, the rate of complications is not significantly increased; in fact, they often have less rejection." Many clinicians and surgeons agree that performing a heart transplant on a patient in renal (kidney) failure is risky. In order to give the patient a fair chance at survival, they recommend that each of the diseased organs should be replaced at the same time (with the organs from a single donor used to avoid compatibility and cross-matching issues). "In a patient with heart and kidney failure, transplantation of the heart alone would still leave the patient with severe kidney disease," says Dr. Khush. "This is detrimental in many ways, most notably in that it would affect the ability to treat the patient with appropriate doses of immunosuppressive medicines and would negatively impact the patient's quality of life, since dialysis patients spend 10 hours per week hooked up to a machine. Also, it would render them more susceptible to infection through dialysis catheters, and immunosuppression from renal failure." Out of twelve heart-kidney transplants that have been performed at the University since 1991, eleven patients have survived –a 92 percent rate of success.
References
Interview with Dr. Kiran Khush, UCSF.
Interview with Teresa De Marco, M.D., F.A.C.C., Professor of Clinical Medicine, Director Heart Failure and Pulmonary Hypertension Programs, University of California, San Francisco Medical Center.
Interview with John Roberts, M.D., Chief of Liver, Kidney and Pancreas Transplant Services at the University of California, San Francisco Medical Center.
Interview with Flavio Vincenti, M.D., a nephrologist and specialist in diseases of the kidney and pancreas in practice at the University of California, San Francisco Medical Center.
Interview with Charles Hoopes, M.D., Director of Heart and Lung Transplants at the University of California, San Francisco Medical Center.
Interview with Kiran Khush, M.D., a Cardiology Fellow at the University of California, San Francisco and the first author of a report that explores important changes in medical perspective as related to treating patients who present with both heart and renal failure (refer to footnote [1]).
Interview with Wayne Teramoto, heart-kidney transplant recipient from Madera, California.
Combined Heart-Kidney Transplantation Reduces Costs and Improves Survival Compared to LVAD Destination Therapy for Patients with Concomitant Heart and Kidney Failure. An abstract presented by Dr. Kiran Khush at the International Society for Heart and Lung Transplantation conference in Madrid, Spain, April 2006. By Kiran Khush, MD; Vivek Bhalla, MD; Celia Rifkin, RN; Karen Rago, RN; Dana McGlothlin, MD; Flavio Vincenti, MD; Donald Hill, MD; Charles Hoopes, MD; Teresa De Marco, MD. From the divisions of Cardiology, Nephrology, and Cardiothoracic Surgery, and Medical Center Administration,University of California, San Francisco.
University of California, San Francisco Medical Center web site (news service overview).
The United Network For Organ Sharing website (www.unos.org).
Chronic Kidney Disease, Dialysis and Transplantation (Companion to Brenner and Rector’s The Kidney). Second Edition. Brian J.G. Pereira, MD; Mohamed H. Sayegh, MD; Peter Blake, MD. Elsevier/Saunders Publishers.
Hurst’s The Heart. 11th Edition. Valentin Fuster, Editor (with others). McGraw-Hill Science.
First published December 21, 2007
Last updated November 10, 2008
Copyright © 2007 Consumer Health Interactive
|
