Irreversible Acute Kidney Injury after Heart Transplantation-Cardiorenal Syndrome Type 1

We report on a case of 55-year-old woman with diabetes, dilatative cardiomyopathy and end-stage heart failure (NYHA IV and ejection fraction of 26%) who underwent orthotopic heart transplantation and subsequently developed irreversible acute kidney injury (AKI) requiring permanent dialysis. Postoperatively she endured multiple problems associated with the orthotopic heart transplant: opportunistic infections, septic shock, and malnutrition. This culminated in anuric renal failure. A cardiorenal syndrome type 1 was diagnosed. Our patient's course illustrates diabetes, pre-existing chronic kidney disease (CKD) and early AKI as identified risk factors for irreversible AKI after heart transplant. The deterioration of renal function after the heart transplantation is associated a with high risk of hospitalization, cardiovascular events and death. The authors analyze the possible pathophysiologic mechanisms and preventive and curative measures.