Combined heart-liver transplantation and Acute Kidney Injury: Risk factors and outcomes from CARDHEPAT registry

Combined heart-liver transplantation (CHLT) offers new possibilities for patients with no other treatment options, yet it remains a rare and complex procedure. Despite an increase in its utilisation in recent years, data remain scarce, and many aspects of the procedure are not yet fully understood, particularly the causes of its significant perioperative morbidity, such as acute kidney injury. The CARDHEPAT study presents the first description of a French regional cohort of CHLT patients. A retrospective analysis of the CARDHEPAT cohort examined 30 CHLTs performed at Assistance Publique - Hôpitaux de Paris (APHP) from January 1, 2002, to January 1, 2022. The aim of this study was to highlight the impact of postoperative KDIGO3 acute kidney injury (AKI) on recipient outcomes and its evolution. KDIGO3 AKI was observed in 50% of cases and was associated with an excess mortality rate among patients undergoing CHLT. At Day-30 and -90, the survival rates with KDIGO3 AKI were 67% and 53%, respectively, compared to 100% and 93% in patients without (p=0.04 and p=0.03). Additionally, we found several intraoperative factors that were associated with the occurrence of postoperative KDIGO3 AKI, including durations of extracorporeal circulation and aortic clamping and level of intraoperative acidosis but also preoperative albuminemia The incidence of KDIGO3 AKI is high after CHLT and seems to be associated with increased mortality, with results suggesting that the intraoperative phase is crucial for its occurrence.