BACKGROUND: In heart transplantation, acute renal failure is not uncommon immediately after heart transplantation. It may be due to pre-existing disease or due to the bypass pump run and/or to the initiation of calcineurin inhibitor therapy. Many patients have temporary hemodialysis and gradually recover normal kidney function. Yet others have chronic kidney failure and require hemodialysis indefinitely. It has not been well established as to the outcomes of these patients after heart transplant.

METHODS: Between 1994 and 2011, we evaluated 52 heart transplant patients who were in need of kidney dialysis in the first 30 days after transplant and after 1 year post-transplant. Patients were divided into those who needed temporary kidney dialysis (resolved prior to 6 months post-transplant) and those with persistent hemodialysis (greater than 6 months post transplant) and those who never required kidney hemodialysis (control group). Outcomes included 5 year survival, development of CAV.

RESULTS: The group requiring persistent dialysis vs those with temporary dialysis and the control group had significantly lower survival (40% vs 78% and 82%, p< 0.001). 5 year freedom from CAV was similar among all 3 groups (see table). 3 other patients had a kidney transplant for persistent renal failure with outcomes comparable to controls.

CONCLUSION: Heart transplant patients requiring persistent hemodialysis have significantly increased mortality risk after heart transplant. Those that require temporary dialysis appear to have comparable outcomes as controls. Persistent dialysis patients require closer monitoring and perhaps consideration for kidney transplant to minimize risk.

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