Acute kidney injury post‐heart transplant: An analysis of peri‐operative risk factors

Abstract

Acute kidney injury is a common complication following heart transplantation, and the factors contributing to acute kidney injury are not well understood. We conducted a retrospective cohort study evaluating patients who underwent heart transplantation between 2009 and 2016 at a single institution. The primary endpoint was incidence of acute kidney injury as defined by Kidney Disease Improving Global Outcomes criteria. Secondary endpoints included 30‐day hospital readmission, 30‐day mortality, and 1‐year mortality. A total of 228 heart transplant patients were included in the study for analysis. In total, 145 (64%) developed acute kidney injury, where 43 (30%) were classified as stage I, 28 (19%) as stage II, and 74 (51%) as stage III. Risk factors found to be associated with the presence of acute kidney injury included increased use of vasopressors and inotropes post‐transplant. Protective factors included cardiopulmonary bypass time <170 min. Acute kidney injury was found to be associated with increased 30‐day and 1‐year mortality.

Incidence and Outcomes Associated With Clostridioides difficile Infection in Solid Organ Transplant Recipients

“…Generally, patients who undergo SOT are susceptible to AKI because of several factors, such as continuous exposure to nephrotoxic drugs, infectious complications, allograft rejection, and comorbidities. 13 , 25 Acute kidney injury is an independent predictor of CDI severity 26 and may occur regardless of fulminant CDI. 27 Patients with CDI may develop AKI because of intrinsic kidney insult; direct toxin-associated kidney disease; and factors that occur before AKI, such as decreased organ perfusion, 28 protein-losing enteropathy leading to reduced oncotic pressure, 29 and immunoglobulin A nephropathy.…”

Risk Factors for Acute Kidney Injury Requiring Renal Replacement Therapy after Orthotopic Heart Transplantation in Patients with Preserved Renal Function

“…Based on the literature research, the following five of the nine significant variables were included into multivariate binary logistic regression (see Table 3 ): ECMO [ 9 , 10 , 11 ], all cause infection after surgery [ 12 , 13 ], levosimendan [ 14 , 15 , 16 ], duration of NE therapy [ 17 , 18 , 19 ] and increase in Tacrolimus plasma levels [ 18 , 20 , 21 ]. Evidence for the choice to include these five variables can be found as references next to each variable.…”

“…Nephrotoxic properties of vasoactive agents by constriction of afferent renal blood vessels are critically discussed. In this context, Jocher et al showed that elevated vasoactive inotropic score at 24 h after surgery was an independent risk factor for early onset AKI in 228 HTX patients [ 17 ]. The vasoactive inotropic score is used to objectively quantify the cardiovascular support of different vasoactive drugs.…”

Machine learning to predict post-operative acute kidney injury stage 3 after heart transplantation

“…FVII was turned out to be a predictor of post-transplant AKI in this study, although consistent with other prior work that higher numbers of transfusions, particularly higher blood and cryoprecipitate transfusion, were associated with the incidence of AKI [ 26 ]. However, In Jocher et al, there were no differences in the intra-op pRBC, FFP, platelets, or coagulation factors between the No-AKI and AKI groups, suggesting that transfusion was not a risk factor of AKI [ 27 ]. The decision to transfuse is influenced by unmeasured factors, such as severity of intraoperative bleeding and pre-existing comorbidities.…”