Article ; Online: Acute Kidney Injury After Heart Transplantation: Risk Factors and Clinical Outcomes.
Journal of cardiothoracic and vascular anesthesia
2024 Volume 38, Issue 5, Page(s) 1150–1160
Abstract: Objective: Acute kidney injury (AKI) requiring renal-replacement therapy (RRT) after heart transplantation (OHT) is common and impairs outcomes. This study aimed to identify independent donor and recipient risk factors associated with RRT after OHT.: ... ...
| Abstract | Objective: Acute kidney injury (AKI) requiring renal-replacement therapy (RRT) after heart transplantation (OHT) is common and impairs outcomes. This study aimed to identify independent donor and recipient risk factors associated with RRT after OHT. Design: A retrospective data analysis. Setting: Data were collected from clinical routines in a maximum-care university hospital. Participants: Patients who underwent OHT. Interventions: The authors retrospectively analyzed data from 264 patients who underwent OHT between 2012 and 2021; 189 patients were eligible and included in the final analysis. Measurements and main results: The mean age was 48.0 ± 12.3 years, and 71.4% of patients were male. Ninety (47.6%) patients were on long-term mechanical circulatory support (lt-MCS). Posttransplant AKI with RRT occurred in 123 (65.1%) patients. In a multivariate analysis, preoperative body mass index >25 kg/m² (odds ratio [OR] 4.74, p < 0.001), elevated preoperative creatinine levels (OR for each mg/dL increase 3.44, p = 0.004), administration of red blood cell units during transplantation procedure (OR 2.31, p = 0.041) and ischemia time (OR for each hour increase 1.77, p = 0.004) were associated with a higher incidence of RRT. The use of renin-angiotensin-aldosterone system blockers before transplantation was associated with a reduced risk of RRT (OR 0.36, p = 0.013). The risk of mortality was 6.9-fold higher in patients who required RRT (hazard ratio 6.9, 95% CI: 2.1-22.6 p = 0.001). Previous lt-MCS, as well as donor parameters, were not associated with RRT after OHT. Conclusions: The implementation of guideline-directed medical therapy, weight reduction, minimizing ischemia time (ie, organ perfusion systems, workflow optimization), and comprehensive patient blood management potentially influences renal function and outcomes after OHT. |
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| MeSH term(s) | Humans ; Male ; Adult ; Middle Aged ; Female ; Retrospective Studies ; Acute Kidney Injury/epidemiology ; Acute Kidney Injury/etiology ; Acute Kidney Injury/therapy ; Risk Factors ; Renal Replacement Therapy ; Heart Transplantation/adverse effects ; Ischemia/etiology |
| Language | English |
| Publishing date | 2024-01-26 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 1067317-9 |
| ISSN | 1532-8422 ; 1053-0770 |
| ISSN (online) | 1532-8422 |
| ISSN | 1053-0770 |
| DOI | 10.1053/j.jvca.2024.01.024 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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