Combined heart and kidney transplantation is performed rarely and merits unique fluid-management considerations postoperatively. We present the case of a young man who developed acute right heart failure after combined heart and kidney transplantation and responded to hemofiltration. We believe that the postoperative management of combined heart and kidney transplant recipients should not be different from that of patients receiving a heart transplant only. Intravenous fluids should be administered judiciously, and hemofiltration should be instituted early to remove fluid and reduce preload if right heart failure develops.