Incidence, Risk Factors and Clinical Outcomes of Acute Kidney Injury after Heart Transplantation: A Retrospective Single Center Study.

Abstract

Objectives: This study aimed to identify the incidence rate of Acute kidney injury (AKI) in our center and predict in-hospital mortality and long-term survival after heart transplantation (HTx). Methods: This single-center, retrospective study from October 2009 and March 2020 analyzed the pre-, intra-, and postoperative characteristics of 95 patients who underwent HTx. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Risk factors were analyzed by multivariable logistic regression models. The log-rank test was used to compare long-term survival. Results: : Thirty-three (34.7%) patients developed AKI. The mortality in hospital in HTx patients with and without AKI were 21.21% and 6.45%, respectively (P<0.05). Recipients in AKI who required renal replacement therapy (RRT) had a hospital mortality rate of 43.75% compared to 6.45% in those without AKI or RRT (P<0.0001). A long cardiopulmonary bypass (CPB) time (OR:11.393, 95% CI: 2.183 to 59.465, P=0.0039) was positively related to the occurrence of AKI. A high intraoperative urine volume (OR: 0.031, 95% CI: 0.005 to 0.212, P=0.0004) was negatively correlated with AKI. AKI requiring RRT (OR, 11.348; 95% CI, 2.418-53.267, P=0.002) was a risk factor for mortality in hospital. Overall survival in patients without AKI at 1 and 3 years was not different from that in patients with AKI (P=0.096).Conclusions: AKI is common after HTx. AKI requiring RRT could contribute powerful prognostic information to predict mortality in hospital. A long CPB time and low intraoperative urine volume are associated with the occurrence of AKI.

Acute Kidney Injury following Cardiopulmonary Bypass: A Challenging Picture

“…Time on CPB. Time on CPB was associated with the risk of developing AKI requiring dialysis [41,[68][69][70][71] In one study, after adjusting for confounders, the association between the time on CPB and AKI requiring dialysis lost its statistical significance [71]. Thus, an accurate risk assessment might be more important than the time on CPB in predicting the occurrence of AKI requiring dialysis.…”