Incidence and Risk Factors for Acute Kidney Injury Post-Heart Transplant: An Analysis of Peri-Operative Hemodynamics

B. Jocher, T. Nakajima, Y. Tanaka, I. Fischer, J. Schilling, G. Ewald, A. Itoh

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Abstract

PURPOSE: Acute kidney injury (AKI) is a common complication following heart transplant and has been found to be associated with increased morbidity and mortality. The goal of this study is to examine pre- and peri-operative risk factors for AKI post-heart transplant and to identify potentially modifiable risk factors. METHODS: We conducted a retrospective cohort study evaluating patients who underwent heart transplant between 2009 and 2016 at a single institution. Data were obtained from the Society of Thoracic Surgeons (STS) national database and retrospective chart review. Exclusion criteria were age <18 years, combined heart/kidney transplant, development of primary graft dysfunction post-transplant as classified by ISHLT guidelines, and death within 24 hrs. The primary endpoint was the incidence of AKI as defined by the Kidney Disease Improving Global Outcome (KDIGO) criteria. Secondary endpoints included impact of AKI on hospital readmission, 30-day mortality, and 1-year mortality. Univariate and multivariate regression were performed. RESULTS: A total of 189 heart transplant patients were included in the study for analysis. In total, 113 (60%) developed AKI, where 37 (33%) were classified as stage I, 23 (20%) as stage II, 53 (47%) as stage III, and 45 patients (24%) required dialysis. Risk factors found to be associated with the presence of AKI included elevated pre-op central venous pressure (CVP) (16 mmHg non-AKI group vs 19 mmHg AKI group, p = 0.020), increased use of vasopressors and inotropes post-transplant, number of blood products transfused (9 vs 11 units, p = 0.009), cardiopulmonary bypass time (163 vs 180 min, p = 0.002), and complications such as delayed sternal closure (19 (29%) vs 48 (45%), p = 0.030). Dialysis after discharge was needed for 7 (8%, p = 0.090) AKI patients. No significant association was found between presence of AKI and hospital readmission, 30-day mortality, and 1-year mortality. CONCLUSION: Risk factors such as elevated pre-op CVP, high use of vasopressors and inotropes, number of blood products transfused, and delayed sternal closure were closely associated with the development of AKI. Delayed sternal closure and number of blood products transfused highlight the impact of bleeding, and the elevated pre-operative CVP is of particular interest due to its potentially modifiable nature.

Original languageEnglish
Pages (from-to)S290
JournalJournal of Heart and Lung Transplantation
Volume39
Issue number4
DOIs
StatePublished - Apr 1 2020

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