# Pediatric heart-kidney transplantation

## TL;DR

This paper reviews the role of heart-kidney transplants in children with heart failure and kidney issues, focusing on patient selection and outcomes.

## Contribution

The paper provides a comprehensive review of evidence and ethical considerations for pediatric heart-kidney transplantation.

## Key findings

- Heart-kidney transplantation improves survival in pediatric patients needing chronic dialysis.
- Differentiating reversible from irreversible kidney injury remains a clinical challenge.
- Perioperative and post-transplant management strategies are critical for successful outcomes.

## Abstract

Heart transplantation is regarded as the definitive treatment for advanced pediatric heart failure. However, concomitant kidney dysfunction often complicates candidate selection for isolated heart transplantation. Prolonged venous congestion, nephrotoxic exposures, and recurrent episodes of acute kidney injury can result in varying degrees of renal impairment. Differentiating between reversible kidney injury secondary to cardiorenal syndrome and irreversible intrinsic renal disease remains a major challenge. Pediatric heart-kidney transplantation has shown survival benefits for patients with end-stage heart failure requiring chronic dialysis, yet its role in patients with less severe renal dysfunction is less clearly defined. This review summarizes the current evidence on patient selection, perioperative and post-transplant management, and ethical considerations for pediatric heart-kidney transplantation.