Predictors of renal replacement therapy after heart transplantation and its impact on long‐term survival

Ivey‐Miranda, Juan Betuel; Flores‐Umanzor, Eduardo; Farrero-Torres, Marta; Santiago, Evelyn; Cepas‐Guillén, Pedro; Pérez‐Villa, Félix

doi:10.1111/ctr.13401

Cited by 11 publications

(16 citation statements)

References 24 publications

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“…The baseline characteristics of our cohort are comparable to that of other large‐scale registry data [2,5,16]. The reported rate of stage 3 AKI requiring RRT in the postoperative period varies considerably from 3.0% to 34.2% [2,11,17–22]. In addition to variable practice and criteria for post‐transplant RRT utilization adopted by different centres, this rate appears to have a temporal trend.…”

Section: Discussionsupporting

confidence: 69%

“…In addition to variable practice and criteria for post‐transplant RRT utilization adopted by different centres, this rate appears to have a temporal trend. For example, the lowest published incidence of postoperative RRT, 3.0%, came from a cohort operated between 1990 and 2000 [2], while the highest incidence, 34.2%, was from a cohort operated between 2009 and 2014 [22]. This temporal trend was also observed in our cohort.…”

Section: Discussionmentioning

confidence: 99%

“…The major separation of the two survival curves occurred in the immediate post‐transplant period. Evidence from previous studies showed that severe AKI was closely associated with other significant complications, such as tamponade, acute right ventricular failure and major bleeding, in the immediate postoperative period [12,22]. Therefore, stage 3 AKI requiring RRT is often a part of multi‐organ failure, which is associated with very poor short‐term prognosis [12,18,19].…”

Section: Discussionmentioning

confidence: 99%

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The impact of severe acute kidney injury requiring renal replacement therapy on survival and renal function of heart transplant recipients – a UK cohort study

Wang

Rushton

et al. 2020

Transpl. Int.

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Severe acute kidney injury (AKI), defined as requiring renal replacement therapy (RRT), is associated with higher mortality postheart transplantation, but its long‐term renal consequences are not known. Anonymized data of 3365 patients, who underwent heart transplantation between 1995 and 2017, were retrieved from the UK Transplant Registry. Multivariable binary logistic regression was performed to identify risk factors for severe AKI requiring RRT, Kaplan–Meier analysis to compare survival and renal function deterioration of the RRT and non‐RRT groups, and multivariable Cox regression model to identify predicting factors of mortality and end‐stage renal disease (ESRD). 26.0% of heart recipients received RRT post‐transplant. The RRT group has lower survival rates at all time points, especially in the immediate post‐transplant period. However, conditional on 3 months survival, older age, diabetes and coronary heart disease, but not post‐transplant RRT, were the risk factors for long‐term survival. The predicting factors for ESRD were insulin‐dependent diabetes, renal function at transplantation, eGFR decline in the first 3 months post‐transplant, post‐transplant severe AKI and transplantation era. Severe AKI requiring RRT post‐transplant is associated with worse short‐term survival, but has no impact on long‐term mortality. It also accelerates recipients’ renal function deterioration in the long term.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The impact of severe acute kidney injury requiring renal replacement therapy on survival and renal function of heart transplant recipients – a UK cohort study

Wang

Rushton

et al. 2020

Transpl. Int.

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“…Reported risk factors for AKI in patients undergoing cardiac transplantation are shown in Table 3. Preoperative risk factors including chronic kidney disease (CKD) [8,19,36,43,51], diabetes mellitus (DM) [36,43], and older age [19,41,52]. were consistently demonstrated as associated risk factors for AKI in patients after cardiac transplantation.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury in Patients Undergoing Cardiac Transplantation: A Meta-Analysis

et al. 2019

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Background: Acute kidney injury (AKI) is a common complication following solid-organ transplantation. However, the epidemiology of AKI and mortality risk of AKI among patients undergoing cardiac transplantation is not uniformly described. We conducted this study to assess the incidence of AKI and mortality risk of AKI in adult patients after cardiac transplantation. Methods: A systematic review of EMBASE, MEDLINE, and Cochrane Databases was performed until June 2019 to identify studies evaluating the incidence of AKI (by standard AKI definitions), AKI requiring renal replacement therapy (RRT), and mortality risk of AKI in patients undergoing cardiac transplantation. Pooled AKI incidence and mortality risk from the included studies were consolidated by random-effects model. The protocol for this study is registered with PROSPERO (no. CRD42019134577). Results: 27 cohort studies with 137,201 patients undergoing cardiac transplantation were identified. Pooled estimated incidence of AKI and AKI requiring RRT was 47.1% (95% CI: 37.6–56.7%) and 11.8% (95% CI: 7.2–18.8%), respectively. The pooled ORs of hospital mortality and/or 90-day mortality among patients undergoing cardiac transplantation with AKI and AKI requiring RRT were 3.46 (95% CI, 2.40–4.97) and 13.05 (95% CI, 6.89–24.70), respectively. The pooled ORs of 1-year mortality among patients with AKI and AKI requiring RRT were 2.26 (95% CI, 1.56–3.26) and 3.89 (95% CI, 2.49–6.08), respectively. Conclusion: Among patients undergoing cardiac transplantation, the incidence of AKI and severe AKI requiring RRT are 47.1% and 11.8%, respectively. AKI post cardiac transplantation is associated with reduced short term and 1-year patient survival.

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“…7,14 There is also one study relating oxygen delivery to the need for renal replacement therapy following heart transplantation. 15 The relationship of perfusion parameters and need for post-operative mechanical support after heart transplantation has remained largely unexamined. For this reason alone, we feel our study represents a novel contribution.…”

Section: Discussionmentioning

confidence: 99%

Relationship of intraoperative perfusion parameters to the need for immediate extracorporeal support following heart transplantation

et al. 2020

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Purpose: We sought to assess the relationship of intraoperative perfusion parameters while on cardiopulmonary bypass, including oxygen delivery (DO2), to the need for ECMO following orthotopic heart transplantation (OHT). Methods: We included all adult (>18 years old) OHTs performed at our institution since implementation of an electronic perfusion record (March 2019-February 2020). Multi-organ transplants were excluded. The primary outcome was the need for immediate venoarterial ECMO in the OR following OHT. Univariable statistics were computed across demographic, clinical, operative, and perfusion variables, including oxygen delivery (DO2) measured each minute. Results: Fifty-three OHT were included with a median age of 54 years (interquartile range, 45-61). The primary outcome occurred in eight patients (15.1%). A significantly greater proportion of patients requiring ECMO had ischemic cardiomyopathy (50.0% (4/8) vs. 15.6% (7/45), p = 0.02) and had preoperative ventricular assist devices (37.5% (3/8) vs. 8.9% (4/45), p = 0.03). Median bypass times were longer in the ECMO group (217 vs. 147 minutes, p = 0.001). Phenylephrine doses were nonsignificantly higher in ECMO patients (4.1 vs. 1.9 mg, p = 0.10). No significant differences were observed in single-point median DO2 (275 vs. 294 mL O2/min/m2 BSA, p = 0.17) and nadir DO2 (226 vs. 222, p = 0.94), but increasing time and depth of DO2 below a threshold of 300 mL O2/min/m2 BSA (i.e. area over the DO2 curve (AOC) but below threshold) was significantly associated with the need for postoperative ECMO (p = 0.04). Conclusion: This is the first study to examine the relationship of perfusion parameters, including oxygen delivery, to outcomes following heart transplantation. We note that DO2 < 300-AOC was significantly associated with the need for postoperative ECMO following heart transplant. Further study will clarify whether potential DO2 differences in patients who require post-OHT ECMO reflect vasoplegia, or a more causative relationship which might be leveraged to improve outcomes.

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Predictors of renal replacement therapy after heart transplantation and its impact on long‐term survival

Abstract: The emergency status of HT, chronic kidney disease, and low oxygen delivery were independent predictors of RRT. The occurrence of RRT increases the risk of death in elective HT as much as in patients with an emergency status.

Cited by 11 publications

References 24 publications

The impact of severe acute kidney injury requiring renal replacement therapy on survival and renal function of heart transplant recipients – a UK cohort study

The impact of severe acute kidney injury requiring renal replacement therapy on survival and renal function of heart transplant recipients – a UK cohort study

Acute Kidney Injury in Patients Undergoing Cardiac Transplantation: A Meta-Analysis

Relationship of intraoperative perfusion parameters to the need for immediate extracorporeal support following heart transplantation

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