Article

Combined Heart-Kidney Transplantation: The University of Wisconsin Experience

Department of Surgery, University of Wisconsin–Madison, Madison, Wisconsin, United States
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation (Impact Factor: 6.65). 12/2007; 26(11):1119-26. DOI: 10.1016/j.healun.2007.08.011
Source: PubMed

ABSTRACT

Combined heart-kidney transplantation (HKTx) is increasing in frequency, but long-term outcomes are unknown and appropriately comparative analysis is lacking.
This study was a retrospective review of prospectively collected data for 19 HKTx patients. Patient and graft survival, graft rejection and coronary allograft vasculopathy (CAV) were compared for HKTx vs recipients of a heart (n = 515) or kidney alone (n = 3,188) or both organs at separate time-points (n = 8).
Patient and graft survival did not differ for HKTx vs any group. HKTx time to first rejection episode was significantly prolonged for both organs vs single-organ recipients. The incidence of CAV was significantly lower for HKTx.
HKTx provides outcomes similar to those for solitary heart or kidney transplantation. There may be an immunologic advantage to receiving organs in a combined fashion. Such allocation of organs seems medically appropriate; however, more refined strategies are needed to identify optimal recipient populations.

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    • "There are now several subsequent reports of lower rates of graft rejection in recipients of combined heart-kidney transplants. A number of other single-centre studies have confirmed that the incidence of cardiac rejection is much lower in recipients receiving combined heart-kidney grafts compared to hearts alone, [70] [71] [72] [73] [74]. All of these studies (except the first which did not assess kidney graft survival) also reported little or no renal graft rejection, despite a lack of HLA matching. "
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    ABSTRACT: The tolerogenic properties of the liver have long been recognised, especially in regard to transplantation. Spontaneous acceptance of liver grafts occurs in a number of experimental models and also in a proportion of clinical transplant recipients. Liver graft acceptance results from donor antigen-specific tolerance, demonstrated by the extension of tolerance to other grafts of donor origin. A number of factors have been proposed to be involved in liver transplant tolerance induction, including the release of soluble major histocompatibility (MHC) molecules from the liver, its complement of immunosuppressive donor leucocytes, and the ability of hepatocytes to directly interact with and destroy antigen-specific T cells. The large tissue mass of the liver has also been suggested to act as a cytokine sink, with the potential to exhaust the immune response. In this review, we outline the growing body of evidence, from experimental models and clinical transplantation, which supports a role for large tissue mass and high antigen dose in the induction of tolerance. We also discuss a novel gene therapy approach to exploit this dose effect and induce antigen-specific tolerance robust enough to overcome a primed T cell memory response.
    Full-text · Article · Nov 2013 · Clinical and Developmental Immunology
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    • "Confirmation of this effect of tissue mass comes from a mouse model where increasing the amount of heart or skin tissue transplanted converted rejection to acceptance [15]. In clinical transplantation too, increasing the amount of donor tissue by performing multiple organ transplants reduces the incidence of acute rejection and allograft vasculopathy compared to single organs [16] [17]. "

    Full-text · Article · Apr 2012
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    • "Confirmation of this effect of tissue mass comes from a mouse model where increasing the amount of heart or skin tissue transplanted converted rejection to acceptance [15]. In clinical transplantation too, increasing the amount of donor tissue by performing multiple organ transplants reduces the incidence of acute rejection and allograft vasculopathy compared to single organs [16] [17]. "
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    ABSTRACT: Operational tolerance (OT) in liver transplant patients occurs much more frequently than OT of other transplanted organs; however the rate of OT varies considerably with the centre and patient population. Rates of OT range from 15% of the total liver transplant (LTX) patient population down to less than 5%. This review examines the reports of liver OT and compares the factors that could contribute to this variation. Multiple factors were examined, including the time from transplantation when weaning of immunosuppression (IS) was commenced, the rapidity of weaning, the contribution of maintenance and induction IS and the patient population transplanted. The approaches that might be used to increase the likelihood of OT are discussed and the approaches to monitoring OT in LTX patients are reviewed.
    Full-text · Article · Feb 2012 · Best practice & research. Clinical gastroenterology
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