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• W4387248810 abstract "SESSION TITLE: Critical Care Case Report Posters 17 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: In recent times, there has been an increase in the number of patients who undergo combined heart and kidney transplantation (HKTx). Compared to patients with single-organ transplantation, there is increased 90-day mortality for HKTx. However, at our institution, we have reported favorable outcomes (discharge to rehab, disability-free days) for these patients, and thus prognosis for HKTx is promising. CASE PRESENTATION: A 57-year-old African-American male with a past medical history of non-ischemic cardiomyopathy with an ejection fraction of 15%, chronic atrial fibrillation (AF), implantable cardiac resynchronization therapy defibrillator, cerebral vascular accident in 2008, stage IV chronic kidney disease, and diabetes, was transferred to our hospital for acute decompensated heart failure complicated by hemorrhagic shock and hemothorax from a lung biopsy. He was transferred to the coronary care unit for further workup and potential cardiac transplantation. He had elevated cardiac filling pressures and then decompensated quickly, requiring the insertion of an intra-aortic balloon pump. He then progressed to biventricular heart failure, required escalation to veno-arterial ECMO, and developed shock liver and acute kidney injury. After stabilization on VA-ECMO, he was transitioned to CentriMag biventricular assist device. His recovery was complicated by acquired paraplegia which was confirmed by electromyography from critical-illness myopathy (CIM), unilateral vocal-cord paralysis from traumatic intubation requiring tracheostomy, and the need for continuous renal replacement therapy. It was deemed recoverable within several months by our neurology team, delaying listing for HKTx. However, after several weeks of intense physical and occupational therapy, he was able to regain upper-body and core strength. Faced with the uncommon presentation of acquired paraplegia from CIM, he was listed as United Network for Organ Sharing (UNOS) Status 1 for HKTx. He underwent heart transplantation approximately two weeks after being listed for HKTx.The kidney transplantation was deferred one day after the heart transplant to allow for stabilization. 48 hours after HKTx, his chest wound closed. His postoperative course was largely uneventful; he was weaned off inotropes and vasopressors within a week, his transplanted kidney was producing urine by postoperative day 8, and his tracheostomy was decannulated on day 10. Approximately 11 days after HKTx, he was transferred out of the intensive care unit. DISCUSSION: Patients with both severe heart and kidney disease have a lower chance of survival with only a heart transplant. The number of simultaneous heart-kidney transplants (sHK) has increased since 2010, but concerns have been raised due to difficulty assessing the added benefit of the transplanted kidney, lack of interdisciplinary criteria for selecting proper candidates, diversion of deceased donor kidneys, and challenges in differentiating reversible kidney injury from advanced intrinsic kidney disease. This case was particularly challenging due to the rarity of solid organ transplantation in patients with acquired paraplegia and CIM. CONCLUSIONS: A high degree of clinical suspicion is required for timely diagnosis and management of heart-kidney failure with simultaneous transplantation to decrease morbidity and mortality. Additionally, acquired paraplegia from CIM is not necessarily an exclusion for solid-organ transplantation, provided that patients can regain upper-body and core strength before transplant. REFERENCE #1: Karamlou T, Welke KF, McMullan DM, et al. Combined heart-kidney transplant improves post-transplant survival compared with isolated heart transplant in recipients with reduced glomerular filtration rate: analysis of 593 combined heart-kidney transplants from the United Network Organ Sharing Database. J Thorac Surg. 2014;147(1):456-461. REFERENCE #2: Grupper A, Grupper A, Daly RC, et al. Renal allograft outcome after simultaneous heart and kidney transplantation. Am J Cardiol. 2017;120(3):494-499. REFERENCE #3: Kobashigawa J, Dadhania DM, Farr M, Tang WHW, Bhimaraj A, Czer L, Hall S, Haririan A, Formica RN, Patel J, Skorka R, Fedson S, Srinivas T, Testani J, Yabu JM, Cheng XS; Consensus Conference Participants. Consensus conference on heart-kidney transplantation. Am J Transplant. 2021 Jul;21(7):2459-2467. DISCLOSURES: No relevant relationships by Adina Bourassa No relevant relationships by Megan Crane No relevant relationships by Hanan Elkalawy No relevant relationships by Dominic Pisano" @default.
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• W4387248810 date "2023-10-01" @default.
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• W4387248810 title "SIMULTANEOUS HEART AND KIDNEY TRANSPLANTATION IN A HIGH-RISK CARDIAC PATIENT WITH CHRONIC KIDNEY DISEASE-DEVELOPED CRITICAL-ILLNESS MYOPATHY" @default.
• W4387248810 doi "https://doi.org/10.1016/j.chest.2023.07.1331" @default.
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