Role of Renal Replacement Therapy During the Peri-Transplant Period of Heart Transplantation

Abstract

Background Heart transplantation (HT) is the most useful treatment modality for heart failure. Although several studies have reported the impact of acute kidney injury (AKI) on clinical outcomes after transplantation, little is known about the impact of peri-transplant renal replacement therapy (RRT) on clinical outcomes. We compared the clinical outcomes according to RRT use status among patients with AKI during the peri-transplant period. Material/Methods The medical records of 21 patients who underwent HT from January 2006 to May 2019 were reviewed. We assessed the heart failure cause, comorbidities, immunosuppressant type, requirement for extracorporeal membrane oxygenation, AKI incidence, and cardiac and renal functions over time. The patients were divided into 3 groups: those without AKI (non-AKI group, n=6), those who underwent perioperative RRT (RRT group, n=10), and those who did not undergo RRT (non-RRT group, n=5). Results The most common cause of HT was dilated cardiomyopathy (52.4%). Fifteen patients (71.4%) experienced AKI during the peri-transplant period. Among them, 9 (90%) in the RRT group underwent continuous RRT and only 1 (10%) underwent intermittent hemodialysis. Until 6 months after HT, the renal function of the RRT group was worse than that of the non-RRT group (estimated glomerular filtration rate 44.2 vs. 69.2 mL/min/1.73 m 2 , P =0.015), but the differences dissipated by 9 months. Finally, all patients, even in the RRT group, withdrew from dialysis. Conclusions RRT during the peri-transplant period in HT may be a good bridge therapy for renal function recovery in patients with cardiorenal AKI.

Determinants of Outcomes of Acute Kidney Injury: Clinical Predictors and Beyond

“…AKI, especially AKI-D, is common and is associated with serious complications after both cardiovascular and non-cardiac surgery [ 51 ]. Patients who require dialysis after surgery may have higher rates of mortality and kidney non-recovery [ 52 , 53 ].…”