Patient with a total artificial heart maintained on outpatient dialysis while listed for combined organ transplant,a single center experience |
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Authors: | Ramy M Hanna Huma Hasnain Mohammad Kamgar Mina Hanna Raffi Minasian James Wilson |
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Affiliation: | 1. Division of Nephrology, Department of Medicine, Ronald Regan Medical Center, David Geffen School of Medicine, UCLA, Los Angeles, California, USA;2. Surgical and Consultative Nephrology, Ronald Regan Medical Center, David Geffen School of Medicine, UCLA, Los Angeles, California, USA;3. School of Medicine, Creighton University Medical Center, Omaha, Nebraska, USA;4. Corporate medical director of home dialysis centers 1500 S Central Ave. Suite # 300, Glendale CA 91204, USA |
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Abstract: | Advanced mechanical circulatory support is increasingly being used with more sophisticated devices that can deliver pulsatile rather than continuous flow. These devices are more portable as well, allowing patients to await cardiac transplantation in an outpatient setting. It is known that patients with renal failure are at increased risk for developing worsening acute kidney injury during implantation of a ventricular assist device (VAD) or more advanced modalities like a total artificial heart (TAH). Dealing with patients who have an implanted TAH who develop renal failure has been a challenge with the majority of such patients having to await a combined cardiac and renal transplant prior to transition to outpatient care. Protocols do exist for VAD implanted patients to be transitioned to outpatient dialysis care, but there are no reported cases of TAH patients with end stage renal disease (ESRD) being successfully transitioned to outpatient dialysis care. In this report, we identify a patient with a TAH and ESRD transitioned successfully to outpatient hemodialysis and maintained for more than 2 years, though he did not survive to transplant. It is hoped that this report will raise awareness of this possibility, and assist in the development of protocols for similar patients to be successfully transitioned to outpatient dialysis care. |
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Keywords: | Hemodialysis cardiomyopathy mechanical circulatory support total artificial heart |
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