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Abstract

Combined heart-kidney transplant has become an alternative for heart transplant candidates with significant chronic kidney disease. However, it is not clear which patients will benefit most from such intervention, and in whom cardiac transplant alone will be sufficient to restore adequate renal function. We report the case of a man with ischemic cardiomyopathy and chronic kidney disease who was wait-listed for heart-kidney transplant after acute decompensated heart failure and renal failure requiring hemodialysis. Because of unexpected circumstances, the kidney transplant was cancelled, and only a heart transplant was performed. Nonetheless, the kidney function rapidly improved beyond the levels before hospitalization and remains stable months after transplant.This case illustrates the difficulties in assessing the reversibility of kidney damage in the context of heart failure requiring transplant. This issue is primordial to improve selection of patients who will benefit most from combined heart-kidney transplant in a context of scarce organ allocation resources.

Prognostic Factors of Renal Outcomes after Heart Transplantation: A Nationwide Retrospective Study

“…Patients with incident CKD after HT were older (patients without incident CKD vs. patients with incident CKD: 45 (37–58) vs. 49 (53–61), p = 0.009) and more frequently males (65.4% vs. 76.0%, p = 0.039), with required mechanical ventilation (20.1% vs. 33.7%, p = 0.003), ECMO (19.5% vs. 28.8, p = 0.035), RRT (16.2% vs. 22.9%, p = 0.018), and inotropes or vasopressors (42.9 vs. 30.8%, p = 0.023) more frequently than those without incident CKD ( Supplementary Material, Table S2 ). ICU length of stay (7 [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ] vs. 10 [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ], p < 0.001) was longer, but hospital length of stay (60 (36–83] vs. 48 (33–73), p = 0.039) was shorter in patients with incident CKD than in those without incident CKD.…”

“…CRS is a leading cause of renal dysfunction in patients with heart failure. Acute CRS is known to be reversible [ 6 , 7 ]; however, there have been conflicting results regarding the clinical impact of pre-HT renal dysfunction on the overall prognosis of HT [ 3 , 8 , 9 , 10 ]. Given the organ shortage and the clinical difficulty of determining the reversibility of renal dysfunction in patients with advanced renal dysfunction being considered for HKT, it is imperative to identify predictive factors of renal outcome after HT.…”