# The Pathological Effects of Cardiac Transplantation in a 27-Year-Old Patient Leading to Cardiac Allograft Rejection and End-Stage Renal Disease: A Case Report

## TL;DR

A 27-year-old heart transplant recipient developed kidney failure and graft rejection, highlighting the long-term risks of heart transplants and the need for combined organ transplants.

## Contribution

This case report emphasizes the importance of dual heart-kidney transplantation in young patients with multisystem failure post-heart transplant.

## Key findings

- The patient developed end-stage renal disease and graft dysfunction 12 years after heart transplantation.
- Dual-organ transplantation is suggested to improve survival in young patients with severe renal dysfunction.
- Early recognition of post-transplant complications is critical for better outcomes.

## Abstract

Heart transplantation remains the gold standard for patients with end-stage heart failure, offering a median survival of 12 years. However, long-term complications, such as cardiac allograft vasculopathy (CAV), infections, malignancies, and renal dysfunction, pose significant challenges. We present the case of a 27-year-old male who underwent heart transplantation at age 15 for dilated cardiomyopathy and now presents with multisystem failure.

The patient arrived at the emergency department with dyspnea, abdominal distention, and respiratory distress. He experienced pulseless electrical activity and was successfully resuscitated and transferred to the ICU. Echocardiography revealed a reduced ejection fraction (30%-35%), consistent with graft dysfunction. Laboratory results showed severe anemia, elevated blood urea nitrogen (BUN) and creatinine levels, and an estimated glomerular filtration rate (eGFR) of 9 mL/min/1.73 m², consistent with end-stage renal disease (ESRD). He was on hemodialysis and long-term immunosuppressive therapy, including tacrolimus and mycophenolate. Despite stabilization, his prognosis remained poor, prompting evaluation for combined heart and kidney transplantation.

This case highlights the long-term risks of heart transplantation, particularly the development of CAV and ESRD. CAV affects over half of recipients within 10 years and can lead to graft failure, while immunosuppressants contribute significantly to renal decline. Recent data suggest that dual-organ transplantation in patients with severe renal dysfunction improves survival outcomes, particularly among younger candidates. However, such decisions involve ethical considerations around organ allocation and long-term outcomes.

Our patient, due to his age and clinical deterioration, was a strong candidate for dual transplantation. This case underscores the importance of early recognition of post-transplant complications and supports the need for individualized, multidisciplinary approaches. As dual transplants become more common, careful patient selection and continued research are essential to maximize outcomes and ensure ethical distribution of scarce resources.