Ruiz-Ortega BA, Basilio-de Leo CI, Martínez-Cabrera C, Mancilla-Urrea E, Aguilar-García HB

Language: Spanish
References: 3
Page: 92-95
PDF size: 1050.39 Kb.

ABSTRACT

Introduction: the prevalence of chronic kidney disease (CKD) among heart transplant (HT) candidates is estimated to be between 20 and 50%. Simultaneous heart-kidney transplantation (SHKT) is a treatment alternative for patients with coexisting advanced renal and cardiac failure; however, its implementation remains a logistical and immunological challenge. Since 2010, the volume of these procedures has steadily increased, and it is estimated that in the United States they represent more than 5% of all heart transplants. However, in Mexico, information is scarce. We present two cases of simultaneous heart-kidney transplantation performed at the National Institute of Cardiology Ignacio Chávez (INCICH) to illustrate the recipient selection process, integrated into a multidisciplinary workflow, and the short-term results. Case presentation: we present two women who underwent SHKT at INCICH. The first patient, a 42-year-old woman, had KDIGO G5A3 chronic kidney disease of undetermined etiology, 15.4 years of renal replacement therapy with hemodialysis (RRT), nine years of anuria and microcysts, dilated cardiomyopathy with a left ventricular ejection fraction (LVEF) of 11%, and high immunological risk; Antibody Reactive Panel (ARP) class I 6% and class II 14%. The second patient, a 38-year- old woman, had KDIGO G4A3 chronic kidney disease due to maladaptive focal segmental glomerulosclerosis, in predialysis status, with severe Ebstein’s anomaly and a right ventricular ejection fraction (RVEF) of 26%; native renal biopsy documented interstitial fibrosis greater than 50% and sclerosis in 70% of the glomeruli, which was the determining criterion for indicating simultaneous kidney transplantation. Both patients exhibited immediate and stable renal allograft function during follow-up, with serum creatinine levels of 0.87 mg/dL and 0.60 mg/dL at 14 and eight months post-transplant, respectively. Conclusion: the interaction between pre-existing kidney disease, perioperative factors, immunosuppressive therapies, and cardiovascular complications makes managing renal function challenging in these patients, who may benefit from simultaneous transplantation.

REFERENCES

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3. García-Cosío-Carmena MD, Farrero M, Blasco-Peiró MT,Crespo M, Delgado-Jiménez J, Díaz-Molina B et al. Managementof kidney disease in heart transplant patients: a National DelphiSurvey-based consensus expert paper. Transplantation. 2025;109 (9): e431-e445.