Complete recovery of acute kidney injury in native kidney following heart kidney transplantation
We report the case of a 23-year-old female who developed severe acute kidney injury (AKI) in the setting of recent onset congestive heart failure secondary to viral cardiomyopathy, cardiogenic shock unresponsive to placement of a biventricular assist device with continued requirement of multiple intravenous pressors, recurrent ventricular tachycardia/fibrillation, and rhabdomyolysis secondary to ischemic necrosis of left leg muscles. Daily slow, low-efficiency dialysis was instituted shortly after admission. Given the possibility of irreversible AKI and the inferior outcomes following heart transplantation alone in patients with perioperative renal dysfunction, she was listed for urgent combined heart-kidney transplantation. Dual transplantation was performed after 9 days of AKI and 7 days on dialysis. Both organs functioned well soon after transplantation. One month post-transplant, recovery of native kidney function with nearly equal contribution to renal function by the native kidneys and the allograft was documented by radioisotopic renography. This case report highlights the difficulty in deciding which patients with severe AKI in the setting of acute heart failure may recover renal function with heart transplantation alone and the need for developing guidelines to help in choosing between heart versus heart-kidney transplantation in such patients.