Recently, Department of Cardiovascular Surgery, Department of Kidney Transplantation, Department of Donor Organ Procurement and Allocation, Department of Anesthesiology and Preoperative Medicine and Department of Ultrasound Medicine of the First Affiliated Hospital of Xi 'an Jiaotong University (XJTU) conducted multidisciplinary team (MDT) cooperation to successfully perform combined heart-kidney transplantation for a uremia patient complicated with dilated cardiomyopathy. This is the first case of combined heart-kidney transplantation completed by our hospital, which is another major breakthrough of multi-organ transplantation technologies, such as combined pancreas-kidney transplantation and combined liver-kidney transplantation, indicating that our hospital’s organ transplantation technologies have covered all organs in the chest and abdomen, reaching international leading levels.
A patient, surnamed Li (anonymous name), received regular peritoneal dialysis for 3 years due to renal failure and uremia. In May 2022, the patient developed chest tightness, shortness of breath and edema of the lower limbs and was diagnosed with renal failure complicated with dilated cardiomyopathy. In October, relevant symptoms were repeatedly worsened. Echocardiography showed that the left ventricle was enlarged complicated with heart insufficiency, and EF value was lower than 30%. Because the patient had end-stage heart function, it was impossible to perform kidney transplantation alone. Combined heart-kidney transplantation was the final resolution.
On October 8, after obtaining the consents from the patient and family relatives, transplantation team from Department of Cardiovascular Surgery registered the patient’s information into China Organ Transplant Response System (COTRS) and put the patient on the waiting list for combined heart-kidney transplantation donors. Meantime, Professor Xue Wujun, Director of Organ Transplantation Center of our hospital took the lead to organize MDT experts from Department of Cardiovascular Surgery, Department of Kidney Transplantation, Department of Cardiovascular Medicine, Department of Donor Organ Procurement and Allocation, Department of Anesthesiology and Preoperative Medicine, Department of Ultrasound Medicine and Department of Blood Transfusion to deliver MDT consultation and explicitly discuss surgical plan.
This is the first combined heart-kidney transplantation completed by the First Affiliated Hospital of XJTU, which is a highly challenging task.
OnDecember 3, our hospital received the donation information, indicating that the matching degree between the donor and recipient was high, and both the heart and kidney sources were obtained from the same donor.
At 17:10 on December 3 , "combined heart-kidney transplantation" was formally started. Zhou Rongsheng, Deputy Chief Physician from Department of Anesthesiology and Perioperative Medicine and Song Yan, Deputy Chief Physician from Department of Ultrasound Medicine also stood by for any emergency event throughout the surgery.
At 17:40, Professor Yan Yang from Department of Cardiovascular Surgery performed heart transplantation.
At 19:47, the transplanted heart started beating, suggesting the success of heart transplantation. The cold ischemia time of heart allograft was only 130 min.
At 20:30, Professor Tian Puxun and Professor Ding Xiaoming from Department of Kidney Transplantation carried out kidney transplantation and completed it at 23:30 . Considering poor function of the right heart, femoro-femoral V-A ECMO implantation was performed simultaneously to ensure the perfusion of kidney allograft and promote the recovery of heart function.
At 1:00 on December 4, combined heart-kidney transplantation was successfully completed. Postoperative parameters were normal and the patient was transferred to ICU for further treatment. The entire surgery endured for 8 h.
