Renal transplantation in congenital heart diseases: A systematic review of outcomes and challenges.

Abstract

Background: Congenital heart disease (CHD) patients increasingly survive into adulthood, yet chronic kidney disease (CKD) is common. End-stage renal disease management is challenging due to hemodynamic instability and perioperative risks. Renal transplantation may improve survival and function, but outcomes are poorly characterized.

Objective: To evaluate graft and patient survival, complications, and clinical considerations in pediatric and adult CHD patients undergoing renal transplantation.

Methods: A PRISMA-compliant systematic review was conducted across PubMed, Embase, Cochrane, Scopus, and Google Scholar through September 2025. Studies reporting renal transplantation outcomes in pediatric or adult CHD populations were included. Data extraction covered study characteristics, demographics, graft and patient survival, complications, and follow-up. Risk of bias was assessed using Joanna Briggs Institute and Newcastle-Ottawa tools. Narrative synthesis was performed.

Results: Seventeen studies (12 case reports, 4 retrospective cohorts, 1 case series) including pediatric (1.2-18 years) and adult (up to 54 years) CHD patients were analyzed. Graft survival was generally favorable, with preserved renal function in most patients. Patient survival was high and comparable to non-CHD recipients, though complex CHD increased perioperative risk. Perioperative complications included prolonged ventilation, transfusion requirements, and extended hospitalization. Urological complications were common, while acute rejection and delayed graft function were infrequent. Cardiovascular events were rare. Multidisciplinary perioperative management improved outcomes.

Conclusion: Renal transplantation is feasible and effective in pediatric and adult CHD populations. Careful patient selection and multidisciplinary care yield high graft and patient survival despite increased perioperative complexity.