Acute Kidney Injury After Heart Transplant: The Importance of Pulmonary Hypertension

Bianco, Juan C.; Stang, María Verona; Denault, André; Marenchino, Ricardo; Belziti, César; Musso, Carlos Guido

doi:10.1053/j.jvca.2020.12.010

Cited by 8 publications

(8 citation statements)

References 44 publications

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“…This was also the case in another study of heart transplants in children used 15 mg/kg of methylprednisolone intraoperatively (13). In other studies, patients received 500-1,000 mg intravenous methylprednisolone during HT surgery (22,23). Our study reveals that an intraoperative methylprednisolone dosage >10 mg/kg is an independent risk factor for requiring RRT treatment within one week of HT (OR 3.197; 95% CI: 1.290-7.923; P=0.012).…”

Section: Discussionmentioning

confidence: 69%

“…However, the dosage of methylprednisolone used in many centers far exceeds the recommended dose. In a single-center study in Argentina, the dose of methylprednisolone used in heart transplant patients was 15 mg/kg (22). This was also the case in another study of heart transplants in children used 15 mg/kg of methylprednisolone intraoperatively (13).…”

Section: Discussionmentioning

confidence: 84%

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

Xie¹,

Fu²,

Wu³

et al. 2022

Ann Transl Med

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Background: Acute kidney injury (AKI) and renal replacement therapy (RRT) are common after heart transplantation (HT). The need for RRT has been reported to be one of the most important predictors of a poor prognosis after HT. Therefore, it is important to early identify risk factors of RRT after HT. However, in the heart transplantation setting, the risk factors are less well studied, and some of the conclusions are controversial. This study aimed to identify the clinical predictors of RRT after HT.Methods: This single-center, retrospective study from January 2010 to June 2021 analyzed risk factors (pre-, intra-, and postoperative characteristics) of 163 patients who underwent HT. The endpoint of the study was RRT within 7 days of HT. Risk factors were analyzed by multivariable logistic regression models.Results: Fifty-five (33.74%) recipients required RRT within 7 days of HT. Factors independently associated with RRT after HT were as follows: a baseline estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m 2 [odds ratio (

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 84%

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

Xie¹,

Fu²,

Wu³

et al. 2022

Ann Transl Med

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“…To define AKI in our study, we used the KDIGO criteria, 30 which was created to standardize and unify AKIN and RIFLE definitions with the advantage of improving the sensitivity of both. 39 Studies which report on AKI following heart transplantation adopt variably either RIFLE, 6,27,28,40 AKIN, 10,41,42 or KDIGO 3,4,7,8,11,12,15,16,21–24 criteria with the latter showing the highest sensitivity. 26 We did not find a difference in the classification rate for severe AKI between the KDIGO and the RIFLE criteria.…”

Section: Discussionmentioning

confidence: 99%

Severe Acute Kidney Injury Postheart Transplantation: Analysis of Risk Factors

Gale,

Al-Soufi,

MacDonald

et al. 2024

Transplantation Direct

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Background. Acute kidney injury (AKI) is a common complication postheart transplantation and is associated with significant morbidity and increased mortality. Methods. We conducted a single-center, retrospective, observational cohort study of 109 consecutive patients undergoing heart transplantation between September 2019 and September 2021 to determine major risk factors for, and the incidence of, severe postoperative AKI as defined by Kidney Disease Improving Global Outcomes criteria in the first 48-h posttransplantation and the impact that this has on mortality and dialysis dependence. Results. One hundred nine patients were included in our study, 83 of 109 (78%) patients developed AKI, 42 (39%) developed severe AKI, and 37 (35%) required renal replacement therapy in the first-week posttransplantation. We found preoperative estimated glomerular filtration rate (eGFR), postoperative noradrenaline dose, and the need for postoperative mechanical circulatory support to be independent risk factors for the development of severe AKI. Patients who developed severe AKI had a 19% 12-mo mortality compared with 1% for those without. Of those who survived to hospital discharge, 20% of patients in the severe AKI group required dialysis at time of hospital discharge compared with 3% in those without severe AKI. Conclusion. Severe AKI is common after heart transplantation. Preoperative kidney function, postoperative vasoplegia with high requirements for vasoactive drugs, and graft dysfunction with the need for mechanical circulatory supports were independently associated with the development of severe AKI in the first-week following heart transplantation. Severe AKI is associated with a significantly increased mortality and dialysis dependence at time of hospital discharge.

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“…PAH is an important risk factor for AKI after transcatheter aortic valve implantation [39] and is closely related to right heart function [40,41]. Reportedly, right ventricular failure is associated with severe postoperative AKI of cardiac surgery [42] and PAH is one of the top ve risk factors, providing a new viewpoint on clinical decision making.…”

Section: Discussionmentioning

confidence: 99%

Machine-learning predictions for acute kidney injuries after coronary artery bypass grafting: A real-life muticenter retrospective cohort study

Jia

Bai

et al. 2023

Preprint

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Background Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) surgery is associated with poor outcomes. The objective of this study was to apply a new machine learning (ML) method to establish prediction models of AKI after CABG. Methods Totally 2780 patients from two medical centers in East China who underwent primary isolated CABG were enrolled. Then the dataset was randomly divided for model training (80%) and model testing (20%). Four ML models based on LightGBM, Support vector machine (SVM), Softmax and random forest (RF) algorithms respectively were established on Python. A total of 2051 patients from two other medical centers were assigned to an external validation group to verify the performances of the ML prediction models. The models were evaluated using the area under the receiver operating characteristics curve (AUC), Hosmer-Lemeshow goodness-of-fit statistic, Bland-Altman plots, and decision curve analysis. The outcome of the LightGBM model was interpreted using SHapley Additive exPlanations (SHAP). Results The incidence of postoperative AKI in the modeling group was 13.4%. Similarly, the incidence of postoperative AKI of the two medical centers in the external validation group was 8.2% and 13.6% respectively. LightGBM performed the best in predicting, with an AUC of 0.8027 in internal validation group and 0.8798 and 0.7801 in the external validation group. The SHAP revealed the top 20 predictors of postoperative AKI ranked according to the importance, and the top three features on prediction were the serum creatinine in the first 24h after operation, the last preoperative Scr level, and body surface area. Conclusion This study provides a LightGBM predictive model that can make accurate predictions for AKI after CABG surgery. This ML model shows good predictive ability in both internal and external validation. It can help cardiac surgeons identify high-risk patients who may experience AKI after CABG surgery.

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Acute Kidney Injury After Heart Transplant: The Importance of Pulmonary Hypertension

Cited by 8 publications

References 44 publications

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

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

Severe Acute Kidney Injury Postheart Transplantation: Analysis of Risk Factors

Machine-learning predictions for acute kidney injuries after coronary artery bypass grafting: A real-life muticenter retrospective cohort study

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