Progress and dilemma in polygonal transplantation

For the past 25 years, Dual Crinic has been provided by dual organ heart transplant. In many cases, the need for polygonal heart transplant occurs for heart failure first for heart failure. Other patients have primary pathology related to the heart at the same time as other organs.

“The median of the patient with a duart lamps plant has been about 10 years, and many patients in the longest program (cardiac lung and heart kidney) have survived for more than 15 years,” said Cardiac Surgeon. I am. Michaelerton, MD, MBACleveland Clinic Director of Heart Transportation and Mechanical Circulation Support. “This is surprising, given how these patients were sick before transplantation.”

Significant increase in volume

In recent years, as reflected in the following graphs, the number of dual -organ heart transplants performed at the Cleveland Clinic has been dramatically increasing (Figure). This increase is due to the combination of factors.

• Increased collaboration between transplanted teams of various related organs
• Experience of gaining experience in enabling surgeons to perform surgery with more complicated patients
• The possibility of obtaining an organ preservation system that enables long organs survival rate after procurement

“In recent years, the number of dual -organ heart transplants has been significantly increased, but we have done it in a very cautious and measured way,” said Dr. Ton.

The oldest Dual Organ Program in the Cleveland Clinic -Cardiocar Pulmonary Transplant -was launched in 1991, and such a 44 transplant was implemented in mid -2024.

Heartkidney transplantation has been one year later, especially in recent years, far exceeding other double transplant cases (cumulative cases in mid -2024).

The latest program, heartbreak, began in 2006, and 18 cases were completed until mid -2024.

“This trend is a significant increase in the number of patients who provide dual organ transplantation,” said Dr. Tong. “In the past, some of these patients may not have been a candidate for surgery, but they will now consider them for multiolgan transplantation.”

Heart Kidney transplantation brings an important dilemma

Many patients who require heart transplant have cardiopulmonary syndrome and sometimes suffer from acute renal failure. For those who only experience heart transplantation, some people have completely recovered the kidneys, while others have to continue dialysis. “Because it is difficult to predict kidney recovery before surgery,” said Dr. Ton, “Providing dual organ transplantation to both heart and renal failure, even if both kidney and renal failure recover. Traditionally made a mistake. “

However, this policy was changed at the Cleveland Clinic from June 2023. This is consistent with a wider national change in the purpose of avoiding excessive treatment of donor organs and unnecessary use. With the current “safety net” protocol, both patients, both heart failure and renal failure, are only in the heart transplant. If the kidneys do not recover 60 days later, the patient can get a high priority list of kidney transplantation.

Another important development is the appearance of a new organ preservation machine that can permeate the kidneys for at least 48 hours after procurement and keep it possible. Dr. Ton explains that the workflow of the Heart Kidney program has fundamentally changed. Previously, regardless of whether the patient was bleeding or the blood circulation unstable, back -to -back heart transplantation and kidney transplantation were required, and the possibility that the kidneys work well immediately after transplantation was reduced.

The new perfusion pump offers valuable time. After the heart transplant, the patient has time to recover with ICU. If necessary, bleeding can be placed under control, and patients can receive dialysis 24 to 36 hours to secure the optimal metabolism before kidney transplantation.

“Since the new system was enacted, we have been transplanting kidney in more stable patients, but we often see the immediate recovery of transplanted kidney with urinary production,” said Dr. Ton. Masu.

Special patient group

The Cleveland Clinic is a large -scale introduction of complex patients, gaining specialized knowledge of special groups of dual organs. For example, it has become one of the world's largest transplant programs for amyloidosis patients.

Patients who have failed in the Fontan circulation also have another unique patient group, and in many cases need to transplant the heart kidney or heart liver. The mortality rate is usually 15 % to 30 % after transplantation, about 5 to 10 times the typical heart transplant speed.

“In my opinion, there is no more difficult surgery as a heart transplant or double organ transplant for patients with Fontan patients,” says Ton. “But if we succeed, the long -term survival of these patients is as good as that of almost all other heart transplant groups.”

An interdisciplinary collaboration is important

Dr. Ton emphasizes that the success of each dual organ transplanted patients needs a close collaboration between at least two surgical specialty (heart surgery and liver/kidney/lung transplant). There are also experts in congenital heart surgery.

Collaboration is also expanded to medical colleagues such as heart failure and heart transplant psychologists. SANJEEB BHATTACHARYA, MD。 “Dual organ transplantation is becoming increasingly important in special groups, especially complicated adult congenital heart disease (ACHD),” says Batachariya. “These are very ill patients living with a lifetime heart disease, which leads to polygonal dysfunction that requires polygon treatment and transplantation. If they provide a transplant option to these complex Achd patients, survive. This is not a dedicated multiol gun approach in various specialized fields.

Dr. Ton agrees. “Our high success rate is due to our extraordinary interdisciplinary joint culture,” he concludes.