March 18, 2009

New Criteria for Transplants

New guidelines could help doctors identify the best candidates for combined heart and kidney transplants.

To gather their data, researchers analyzed data from more than 19,000 patients who underwent heart or combined heart and kidney transplants between 1995 and 2005. They found patients were less likely survive a combined heart and kidney transplant if, before surgery, they were older than 65, had peripheral vascular disease, had heart failure not caused by blocked or narrowed arteries, were dependent on dialysis or had been placed on a ventricular assist device to help the heart survive to transplantation.

Based on those risk factors, patients can be placed in one of three risk groups. Those in the lowest-risk group show a one-year survival rate of 93.2 percent following combined heart and kidney transplant, while those in the highest-risk group had only 61.9 percent survival after one year.

Infection was the most common cause of death for those in the highest-risk group. In particular, patients bridged to transplantation on a ventricular assist device, had peripheral vascular disease or were older than 65 were more vulnerable to infection, thus increasing their risk of death.

"Among patients with combined kidney failure and heart failure, those classified by this risk stratification scheme as low-risk should undergo combined heart and kidney transplantation, while there is no demonstrable benefit for combined heart and kidney transplantation over heart transplantation alone in patients classified as high-risk," study authors wrote.

SOURCE: Archives of Surgery, 2009;144:241-246