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Master Thesis

Évolution rénale dans la transplantation combinée rein-coeur

Abstract : Introduction : simultaneous heart-kidney transplant (HKTx) is a valid treatment for patients with coexisting heart and renal failure. Preventing postoperative renal failure increases survival after heart transplantation (HTx). The aim of this study was to assess renal outcome in HKTx and to identify predictive factors for renal loss. Methods : a retrospective study was conducted among HKTx recipients at 8 French centers from 1988 to 2017. Donors’ and recipients' medical records were reviewed to evaluate patients’ and renal transplants’ survival and their prognostic factors. Results : 73 recipients were included with a mean follow-up of 5.36 years. Mean ischemia time was 189 and 710 minutes for HTx and renal transplantation (KTx). Renal primary non-function occurred in 2.7%, complications Clavien IIIb or higher were observed in 67.1% including 16 postoperative deaths (22%). Mean 1-year CKD-EPI was 57.4 ml/min. 5-year overall and renal survival were 74.5% and 69.4%. Among survivors, 7 returned to dialysis during follow-up. In multivariate analysis, the use of ECMO (HR=6.04, p=0.006), dialysis (HR=1.04/day, p=0.022) and occurrence of postoperative complications (HR=31.79, p=0.022) were independent predictors of mortality but not the history of previous HTx or KTx nor renal function prior to Tx. History of KTx (HR=2.52, p=0.026) and increased delay between the two Tx (HR=1.25/hour, p=0.018) were associated with renal transplant failure. Conclusion : HKTx provides good renal transplant survival and function among survivors. Early mortality rate of 22% underlines the need for identifying high risk patients who will not benefit from HKTx in order to allocate the renal graft to another recipient.
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Master Thesis
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Submitted on : Wednesday, October 2, 2019 - 3:30:02 PM
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Théodore Toinet. Évolution rénale dans la transplantation combinée rein-coeur. Médecine humaine et pathologie. 2018. ⟨dumas-02303756⟩



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