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Mitigating Risk of Kidney Dysfunction After Heart Transplantation and Therapeutic Approaches
Ersilia M DeFilippis1, Richard K Cheng2, Elena M Donald1
1Department of Medicine, Center for Advanced Cardiac Care, Division of Cardiology, New York Presbyterian-Columbia University Irving Medical Center (E.M. DeFilippis, E.M. Donald).
Circulation. Heart Failure
|February 23, 2026
Summary
Kidney dysfunction after heart transplantation (HT) is a growing concern, impacting patient survival. This review explores kidney injury risks, mitigation strategies, and future directions for heart transplant recipients.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Kidney dysfunction is a significant complication following heart transplantation (HT), leading to increased morbidity and mortality.
- The incidence of acute and chronic kidney dysfunction is rising post-2018 US allocation system, linked to mechanical support use and altered recipient profiles.
- Existing nephroprotective therapies for chronic kidney disease in heart failure patients show promise, but data in HT recipients are emerging.
Purpose of the Study:
- To review the epidemiology of kidney dysfunction after heart transplantation.
- To examine mitigation strategies for acute kidney injury and chronic kidney disease in HT recipients.
- To discuss the need for kidney transplantation post-HT and outline future research directions.
Main Methods:
- Systematic literature review of existing studies on kidney dysfunction post-heart transplantation.
- Critical analysis of epidemiological data, risk factors, and outcomes.
- Evaluation of current and emerging pharmacotherapeutic and non-pharmacotherapeutic interventions.
Main Results:
- Kidney dysfunction is a prevalent and increasing issue after heart transplantation.
- Recipient and perioperative factors significantly influence the risk of kidney injury.
- Emerging data suggest potential benefits of certain nephroprotective agents in HT recipients.
Conclusions:
- Kidney dysfunction poses a substantial threat to heart transplant recipients, necessitating focused attention.
- Proactive strategies for preventing and managing kidney injury are crucial.
- Further research is needed to optimize kidney care and transplantation outcomes in this population.
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