Risk score helps identify candidates for combined heart and kidney transplants

Mar 16, 2009

Researchers have identified a set of criteria that, when combined with a measure of kidney function, could help identify patients who are likely to receive a survival benefit from a combined heart and kidney transplant, according to a report in the March issue of Archives of Surgery, one of the JAMA/Archives journals.

"In the past, with end-stage failure having concurrent renal [] disease were not considered candidates for ," the authors write as background information in the article. "With advances in operative techniques and perioperative [around the time of surgery] management, and kidney transplantation is offered to select patients in this population."

A 1997 article demonstrated that heart and recipients have similar survival rates as recipients of alone. However, there are still no standardized guidelines for heart and kidney transplants, despite an increasing number of these procedures being performed. In a new study, Mark J. Russo, M.D., M.S., of Columbia University Medical Center/New York-Presbyterian Hospital, New York, and colleagues analyzed data from the United Network for Organ Sharing (UNOS) for 19,373 patients who underwent heart transplantation between 1995 and 2005. This included 274 patients who received combined heart and kidney transplants and 19,109 who received heart transplants alone. The researchers assessed illness status as assigned by UNOS, pretransplantation demographics and medical history to determine which factors affected survival.

Patients appeared less likely to survive following a combined heart and kidney transplant if, before surgery, they had peripheral vascular disease (disease of the blood vessels outside the heart and brain), were older than 65, had that was nonischemic (not caused by blocked or narrowed arteries), were dependent on dialysis or were placed on a ventricular assist device (pumping device that assists the heart) as a bridge to transplantation. When patients were stratified into three groups based on these risk factors, the one-year survival rate was 93.2 percent for those in the lowest-risk group and 61.9 percent for those in the highest-risk group.

Previous studies have shown that patients with an estimated glomerular filtration rate (eGFR, a measure of kidney function) of less than 33 milliliters per minute have decreased survival following heart transplantation, the authors note. When the authors further stratified patients in the study based on eGFR, patients with an eGFR of less than 33 milliliters per minute who were in the low-risk group appeared to survive longer following heart and kidney transplants than following heart transplants alone.

About one-fourth of patients in the highest-risk group died from infection. Patients who were bridged to transplantation with a ventricular assist device, had peripheral vascular disease or were older than 65 appeared more vulnerable to infection, explaining their increased risk of death. The underlying reasons for the increased risk of death due to nonischemic heart failure remains unclear, the authors note.

More information: Arch Surg. 2009;144[3]:241-246

Source: JAMA and Archives Journals (news : web)

Explore further: FTC clears Sun Pharma's $4B purchase of competitor Ranbaxy

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

Why aren't there any human doctors in Star Wars?

Jan 30, 2015

Though set "a long time ago in a galaxy far, far away," it isn't hard to see in the Star Wars films a vision of our own not so distant future. But Anthony Jones, a physician with a long background in health ...

Cambodia bans 'virgin surgery' adverts

Jan 29, 2015

The Cambodian government has ordered a hospital to stop advertising so-called virginity restoration procedures, saying it harms the "morality" of society.

What's happening with your donated specimen?

Jan 28, 2015

When donating blood, plasma, human tissue or any other bodily sample for medical research, most people might not think about how it's being used. But if you were told, would you care?

Amgen tops Street 4Q forecasts

Jan 27, 2015

Amgen Inc. cruised to a 27 percent jump in fourth-quarter profit and beat Wall Street expectations, due to higher sales of nearly all its medicines, tight cost controls and a tax benefit.

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.