• Fernando A Atik, Carolina de Fatima Couto, Silvia Emanoella Martins de Souza, Rodrigo Santos Biondi, Adegil Henrique Miguel da Silva, Murilo F Vilela, Vitor S Barzilai, Helen Souto Siqueira Cardoso, and Marcelo B Ulhoa.
• Instituto de Cardiologia do Distrito Federal, Brazil; University of Brasilia, Brasilia, DF, Brazil. Electronic address: atikf@me.com.
• J. Cardiothorac. Vasc. Anesth. 2022 Feb 1; 36 (2): 437-443.

ObjectiveHeart transplantation in the setting of renal insufficiency is controversial. The objective of this study was to perform a descriptive analysis of patients who underwent orthotopic heart transplantation and renal replacement therapy (RRT) due to acute kidney injury (AKI).DesignAn observational cohort study with retrospective data collection.SettingA tertiary care hospital.ParticipantsFifty-one patients underwent orthotopic heart transplantation with cardiogenic shock under inotrope dependence, with nine patients having preoperative RRT and 42 patients not having preoperative RRT.InterventionsThere were no interventions.Measurements And Main ResultsHospital mortality occurred in eight (15.6%) patients. Although there were no significant differences between the study groups (preoperative RRT 33.3% v controls 11.9%, p = 0.1), this study was underpowered to detect differences in mortality. Dialysis also was required in 52.4% of patients who were not on preoperative RRT. All survivors had full recovery of kidney function with similar timing after transplant (18.5 days v 15 days, p = 0.75). Actuarial survival was 82.4%, 76.5%, and 66.5% at six months, one year, and five years, respectively. A cold ischemic time greater than 180 minutes (hazard ratio [HR] 4.37 95% confidence interval [CI] 1.51-12.6; p = 0.006) and pretransplant RRT (HR = 7.19 95% CI 1.13-45.7; p = 0.04) were independent predictors of long-term mortality.ConclusionsIn a health system with limited funding and availability of mechanical circulatory support, heart transplantation in the setting of AKI, RRT, and low Interagency Registry for Mechanically Assisted Circulatory Support profile was associated with important hospital mortality. Among hospital survivors, however, all patients had full renal recovery and by 25 months there was no difference in mortality between those who required preoperative RRT and those who did not.Copyright © 2021 Elsevier Inc. All rights reserved.

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