Combined heart and kidney transplantation

The first reported combined heart and kidney transplant occurred in 1978.1 The patient died of gram negative sepsis 15 days after transplantation. It was not until 1986 that a case was reported with long-term (> 18-month) survival.2 Since that time, there have been more than 40 publications examining the pros and cons of simultaneous heart and kidney transplantation. Initial reports consisted mainly of small case series demonstrating proof of concept and adequate 1–3 year survival, mostly in line with that of heart transplantation alone.3-5 Later it was noted that simultaneous transplantation seemed to protect against rejection of the heart transplant (although different immunosuppressive protocols were frequently employed) and that rejection of one organ often occurred independently of immunological damage to the other.