Impact of autologous platelet rich plasma use on postoperative acute kidney injury in type A acute aortic dissection repair: a retrospective cohort analysis

Abstract

Background Perioperative coagulopathy and blood transfusion are common in patients undergoing Stanford type A acute aortic dissection (AAD) repair. The autologous platelet-rich plasmapheresis (aPRP) technique is a blood conservation approach to reduce blood transfusions and morbidity in patients at high risk of bleeding. The purpose of this study was to analyze the effect of aPRP on outcomes, especially in postoperative acute kidney injury (post-AKI), in patients undergoing AAD surgery. Methods Six hundred sixty patients were divided into aPRP and non-aPRP groups according to aPRP use. The primary endpoint was the difference in the incidence of post-AKI between two groups. The secondary endpoints were risk factors for post-AKI and to assess clinical outcomes. The risk factors associated with post-AKI were calculated, and all outcomes were adjusted by propensity-score matching analysis. Results A total of 272 patients (41.2%) received aPRP, whereas 388 were in the non-aPRP group. Compared to non-aPRP group, the occurrence of post-AKI increased by 14.1% (p = 0.002) and 11.1% (p = 0.010) with and without propensity adjustment in the aPRP group, respectively. The aPRP group required fewer intraoperative transfusions (p < 0.05) and shortened the duration of mechanical ventilation (p < 0.05) than those in the non-aPRP group. Multiple regression analyses showed that aPRP (odds ratio: 1.729, 95% confidence interval: 1.225–2.440; p < 0.001) was one of the independent risk factors for post-AKI. Conclusions The use of aPRP significantly reduced intraoperative blood transfusions and decreased postoperative mortality-adjusted mechanical ventilation. However, aPRP use was independently associated with an increased hazard of post-AKI after adjusting for confounding factors.

Effect of autologous platelet-rich plasma on patients with acute type A aortic dissection underwent aortic arch replacement: a retrospective cohort study

“…Some studies showed that PRP can decrease the length of ICU stay [7,8], decrease the mean number of ventilator days [7][8][9] and the incidence of tracheostomy [7,9], and decrease the length of hospital stay[8, 10], while another study showed that PRP application might increase the risk of postoperative acute kidney injury, without decreasing the length of hospital stay or in-hospital mortality. [11] Consistent with the abovementioned studies, we found that the incidence of perioperative cryoprecipitate transfusion was reduced in the PRP group compared to the non-PRP group. Unexpectedly, we observed no signi cant differences in other blood product transfusions between the two groups, including packed red blood cells and fresh frozen plasma.…”

“…These results contrast with those of Tong, who showed that patients in the PRP group showed higher Scr and lactic acid levels, which were associated with a higher incidence of acute kidney injury on postoperative day 1-3. [11] The diversion may come from different transfusion amounts, anesthesia routines, or operation details. Simultaneously, the results showed no differences in AST and ALT levels, which serve as markers of acute liver injury, between the two groups.…”

“…The use of PRP can maintain normal platelet function, preserve plasma volume, and ultimately reduce the transfusion volume. [11] But whether it can decrease postoperative complications and improve short-term outcomes is under debate. Some studies showed that PRP can decrease the length of ICU stay [7,8], decrease the mean number of ventilator days [7][8][9] and the incidence of tracheostomy [7,9], and decrease the length of hospital stay[8, 10], while another study showed that PRP application might increase the risk of postoperative acute kidney injury, without decreasing the length of hospital stay or in-hospital mortality.…”

Serum Lactate Level in Early Stage Is Associated With Acute Kidney Injury in Traumatic Brain Injury Patients

“…The relation between increased age and AKI development in patients with TBI may be attributable to physiological changes in renal function and multiple comorbidities with age. In some studies, transfusion of FFP or platelet was confirmed as independent risk factor of AKI (42)(43)(44)(45)(46). Massive FFP transfusion may aggravate the impaired renal function through activating inflammatory and immunologic reactions (47,48).…”

The association between lymphocyte-monocyte ratio and postoperative acute kidney injury in patients with acute type A aortic dissection

“…Emergency cardiac surgery has great curative effect on ATAAD [3][4][5]. However, a fraction of ATAAD patients may experience postoperative acute kidney injury (AKI), which may result in mortality and poor prognosis in ATAAD patients, even though they have undergone standard emergency cardiac surgery [6][7][8]. Therefore, it is meaningful to explore the useful biomarker that is able to predict postoperative AKI in ATAAD patients who undergo emergency cardiac surgery.…”