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Objective To investigate the risk factors of early stage renal replacement therapy for acute kidney injury after heart transplantation and its effect on short-term prognosis. Methods We retrospectively studied 77 consecutive heart transplant recipients from January 2013 to June 2019，15 patients of them accepted renal replacement treatment for acute kidney injury at early stage（RT group），and the other 62 patients didn`t（NRT group）. The age，BMI，protopathy，renal function before operation，operation model，duration of cardiopulmonary bypass，aortic crossclamp time，volume of blood transfusion and fresh frozen plasma transfusion were comparedbetween the two groups，and the 28 d mortality were analyzed. Results The patients of RT group were older thanthat of NRT group〔（58.70±7.70）years vs（52.80±12.70）years，P ＝ 0.028〕. The estimated glomerular filtration rate（eGFR）before operation were much lower in RT group〔（61.00±22.86）ml/min vs（75.34±25.16）ml/min，P ＝ 0.048〕. And more fresh frozen plasma were transfused to patients of RT group〔（1423.33±572.44）ml vs（1053.71±560.77）ml，P ＝ 0.024〕. Besides，most patients accepted heart transplantation，two patients in RT group accepted intra-aortic balloon pulsation simultaneously and 1 patients in NRT group accepted combinedcardiopulmonary transplantation. Patients with renal replacement therapy had a greater 28 d mortality（53.33% vs 8.06%，P ＜ 0.001）. Conclusion The early stage renal replacement therapy after heart transplantation is a frequent complication associated with a high short-term mortality and is mainly associated with older age，preoperative renal function impairment and more fresh frozen plasma transfusion during operation.

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