Combined heart-liver transplantation and Acute Kidney Injury: Risk factors and outcomes from CARDHEPAT registry - 18/11/25

Doi : 10.1016/j.liver.2025.100305

Andre Cordeiro ^a,^⁎ , Pascal Lebray ^b, Romain Guillemain ^c, Samy Meriem ^d, Fabiano Perdigao ^e, Adrien Bougle ^a, Olivier Scatton ^e, Pascal Leprince ^f, Shaida Varnouss ^g, Eric Savier ^e, Alain Combes ^h, Geraldine Rousseau ^e, Bernard Cholley ⁱ, Bastien Genet ^j, Benjamin Granger ^d, Antoine Monsel ^a, Daniel Eyraud ^a,^⁎

^a Department of Anaesthesiology and Critical Care, La Pitié Salpêtrière Hospital, DMU DREAM, APHP, Sorbonne University, Paris, France

^b Department of Hepatology, La Pitié Salpêtrière Hospital, APHP, Sorbonne University, Paris, France

^c Department of Cardiology, Georges Pompidou European Hospital, AP-HP, Paris Cité University, Paris, France

^d Department of Public Health, La Pitié Salpêtrière Hospital, DMU Esprit, AP-HP, Sorbonne University, Paris, France

^e Department of Hepatobiliary Surgery, APHP, Hôpital La Pitié Salpêtrière, Sorbonne University, Paris, France

^f Department of Cardiovascular and Thoracic Surgery, La Pitié Salpêtrière Hospital, Institute of Cardiology, APHP, Sorbonne University, Paris, France

^g Department of Cardiology, APHP, La Pitié Salpêtrière Hospital, Institute of Cardiology, APHP, Sorbonne University, Paris, France

^h Department of Intensive Care Medicine, La Pitié Salpêtrière Hospital, Institute of Cardiology, APHP, Sorbonne University, Paris, France

ⁱ Department of Anaesthesiology, Intensive Care, and perioperative medicine, Georges Pompidou European Hospital, AP-HP, Paris Cité University, INSERM UMR-S1140 “Innovations Thérapeutiques en Hémostase”, Paris, France

^j Institute Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Equipe PEPITES, Sorbonne University, INSERM, AP-HP, La Pitié Salpêtrière Hospital, Department of Public Health, Paris, France

^⁎ Correspondence authors at. Département d’Anesthésie-Réanimation, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Sorbonne Université 47-83 boulevard de l’Hôpital, F-75013 Paris, France. Département d’Anesthésie-Réanimation Hôpital Pitié–Salpêtrière Assistance Publique–Hôpitaux de Paris Sorbonne Université 47-83 boulevard de l’Hôpital Paris F-75013 France ^⁎⁎ Département d’Anesthésie-Réanimation, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Sorbonne Université 47-83 boulevard de l’Hôpital, F-75013 Paris, France. Département d’Anesthésie-Réanimation Hôpital Pitié–Salpêtrière Assistance Publique–Hôpitaux de Paris Sorbonne Université 47-83 boulevard de l’Hôpital Paris F-75013 France

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Abstract

Background

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.

Methods

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.

Results

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

Conclusion

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.

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Key words : Combined transplantation, Heart-liver transplantation, Anaesthesia, Postoperative complications, Acute kidney injury

Abbreviations : AKI, ASA, CHLT, CKD, CPB, ECMO, FFP, GFR, KDIGO, LVEF, MELD, NYHA, RRT

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Combined heart-liver transplantation and Acute Kidney Injury: Risk factors and outcomes from CARDHEPAT registry - 18/11/25

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