Preponderance of microbial isolates among heart transplantation recipients requiring renal replacement therapy: a propensity score-adjusted analysis

Abstract

AimTo assess the association between renal replacement therapy (RRT) and post-transplant infection incidence.MethodsThis single-center retrospective cohort study included 158 patients who underwent heart transplantation (HTx) in our center from 2008 to 2016, survived beyond the first post-procedural day, and had available microbial data. The patients were dichotomized according to the need for periprocedural RRT. Twenty-seven patients in RRT group had lower preoperative creatinine clearance, greater body mass index, and higher likelihood of having diabetes. Propensity score adjustment was used to account for multiple covariates. The primary outcome measure was the presence of bacteremia in patients with and without the need for RRT. The secondary outcome measures were the presence of microbial isolates from any culture and clinical outcome data.ResultsUnadjusted analysis showed that the RRT group had higher incidence of any positive microbial isolate (93% vs 73%; odds ratio [OR] 4.77, 95% confidence interval [CI] 1.01-30.53; P = 0.026) and an increased susceptibility to bacteremia (50% vs 22%; OR 3.50, 95% CI 1.28-9.67; P = 0.012). Propensity score-adjusted analysis corroborated the between-group difference in positive blood cultures (OR 3.97, 95% CI 1.28-12.32; P = 0.017). There was no difference in the incidence of total microbial isolates between the groups (OR 4.55, 95% CI 0.90-23.05; P = 0.067).ConclusionsPatients requiring RRT after HTx had an increased susceptibility to infections via various portals of entry, predominantly due to an increase in blood-borne infections. Understanding the underlying conditions leading to infection-related morbidity is important for infection control and prevention.

Severe Acute Kidney Injury Postheart Transplantation: Analysis of Risk Factors

“…54 Consistent with this, we found that mechanical circulatory support in the first 48-h postheart transplantation was independently associated with the development of severe AKI, which has be reported by others. 9,21 All patients in our study who required mechanical circulatory support developed severe AKI and more than half of the severe AKI group had moderate-to-severe graft dysfunction or required mechanical support.…”

“…Others have found an association between transfusion and AKI postheart transplantation. 3,9,27 Karkouti summarizes a large number of observational studies investigating the association of blood transfusion with AKI in cardiac surgery patients and summates that each unit of blood transfusion is independently associated with a 10% to 20% risk of AKI. 52 We found preoperative eGFR to be an independent risk factor for the development of severe AKI, this has been frequently shown by others.…”

“…The reported incidence of AKI following heart transplantation varies between 14% and 83% and reported rates of renal replacement therapy (RRT) range from 5% to 46%. 2–29 The consequences of developing AKI can be severe due to complex cardiorenal interactions and the impact on inflammatory cascades among numerous other effects. It has been shown that severe renal impairment in the early postoperative period is associated with increased early and late mortality, mechanical ventilation duration, length of stay, and healthcare-associated costs.…”

“…It has been shown that severe renal impairment in the early postoperative period is associated with increased early and late mortality, mechanical ventilation duration, length of stay, and healthcare-associated costs. 2–29…”

Risk factors of renal replacement therapy after heart transplantation: a retrospective single-center study

“…Previous studies have reported that risk factors for RRT after heart transplantation include history of CKD (15,16), history of hypertension (17), history of diabetes (15,16), liver disease (17), intraoperative cardiopulmonary bypass (CPB) time (16), postoperative ventricular assist device (VAD)/extracorporeal membrane oxygenator (ECMO) therapy (18) and mechanical ventilation (17). Boyle et al (16) showed that increased CPB time was an independent risk factor for RRT after HT, but this conclusion was not confirmed in the studies by Gašparović et al (19). The study conducted by Ivey-Miranda et al revealed that CKD was an independent predictor of RRT after HT (8), but Nadkarni et al cannot get this conclusion in patients who received HT (17).…”