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Severe Acute Kidney Injury Postheart Transplantation: Analysis of Risk Factors
David Gale1, Suhel Al-Soufi1,2, Peter MacDonald2,3,4
1Department of Intensive Care, Intensive Care, St Vincent's Hospital, Sydney, NSW, Australia.
Transplantation Direct
|February 21, 2024
Summary
Severe acute kidney injury (AKI) is common after heart transplantation. Preoperative kidney function and postoperative vasopressor use are key risk factors, leading to increased mortality and dialysis dependence.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Acute kidney injury (AKI) is a frequent and serious complication following heart transplantation.
- AKI is linked to increased patient morbidity and mortality rates.
Purpose of the Study:
- To investigate the incidence and primary risk factors of severe AKI within 48 hours post-heart transplantation.
- To assess the impact of severe AKI on mortality and long-term dialysis dependence.
Main Methods:
- A retrospective observational cohort study included 109 heart transplant recipients (September 2019 - September 2021).
- Data analyzed included preoperative kidney function, postoperative medication use, and need for mechanical circulatory support.
Main Results:
- 78% of patients developed AKI, with 39% experiencing severe AKI within the first week.
- Independent risk factors for severe AKI included lower preoperative eGFR, higher postoperative noradrenaline dose, and need for mechanical circulatory support.
- Severe AKI was associated with 19% 12-month mortality versus 1% in non-AKI patients.
- 20% of severe AKI survivors required dialysis at discharge, compared to 3% without severe AKI.
Conclusions:
- Severe AKI frequently occurs after heart transplantation.
- Preoperative kidney function, vasoplegia requiring vasoactive drugs, and graft dysfunction necessitating mechanical circulatory support are associated with severe AKI.
- Severe AKI significantly increases mortality and dialysis dependence post-transplant.
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