Первинна дисфункція графта після трансплантації серця: випадок успішного лікування із застосуванням безперервної ниркової замісної терапії

Svitlana  Romanenko; Serhii  Sudakevych; Igor  Kuzmych; Sofia  Сhaikovska; Stepan  Maruniak; Iryna  Shifris; Gavrylo  Kovtun; Borys  Todurov

doi:10.31450/ukrjnd.3(87).2025.03

Svitlana Romanenko Heart Institute of the Мinistry of Health of Ukraine, Kyiv, Ukraine https://orcid.org/0009-0008-2301-7661
Serhii Sudakevych Heart Institute of the Мinistry of Health of Ukraine, Kyiv, Ukraine; Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-9253-9593
Igor Kuzmych Heart Institute of the Мinistry of Health of Ukraine, Kyiv, Ukraine https://orcid.org/0009-0007-8326-5264
Sofia Сhaikovska Heart Institute of the Мinistry of Health of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0001-9847-7760
Stepan Maruniak Heart Institute of the Мinistry of Health of Ukraine, Kyiv, Ukraine; Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0001-7538-2443
Iryna Shifris State Institution “O.O. Shalimov National Scientific Center of Surgery and Transplantology of the National Academy of Medical Science of Ukraine,” Kyiv, Ukraine; Heart Institute of the Мinistry of Health of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-9413-7301
Gavrylo Kovtun Heart Institute of the Мinistry of Health of Ukraine, Kyiv, Ukraine; Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0001-9689-2055
Borys Todurov Heart Institute of the Мinistry of Health of Ukraine, Kyiv, Ukraine; Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine https://orcid.org/0009-0000-2047-4447

DOI: https://doi.org/10.31450/ukrjnd.3(87).2025.03

Keywords: heart transplantation, primary graft dysfunction, acute kidney injury, renal replacement therapy, cardiac surgery

Abstract

Heart transplantation remains the only definitive treatment for end-stage heart failure. According to the literature, primary graft dysfunction (PGD) is the leading cause of 30-day mortality after transplantation, with acute kidney injury (AKI) being one of its most frequent and serious complications.

We present one of the few detailed case reports describing the successful management of PGD complicated by vasoplegia and AKI after heart transplantation using prolonged continuous kidney replacement therapy (CKRT) without mechanical circulatory support.

On the first postoperative day, the patient developed PGD with concurrent AKI. CKRT was initiated early and performed for six days with a total duration of 135 hours. Serial monitoring demonstrated progressive improvement in biochemical parameters and acid-base status (urea, creatinine, potassium, lactate), hemodynamic stabilization, and restoration of urine output.

This case suggests that early initiation and prolonged use of CKRT may improve outcomes in patients with PGD and concomitant AKI after heart transplantation.