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Perioperative Risk Factors of Acute Kidney Injury After Heart Transplantation and One-Year Clinical Outcomes: A

Geoffroy Hariri1, Paul Henocq2, Guillaume Coutance3

  • 1Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Département d'anesthésie et réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France.

Journal of Cardiothoracic and Vascular Anesthesia
|April 25, 2024
PubMed

Insights

Acute kidney injury (AKI) affects 64% of heart transplant recipients. High BMI, prolonged cold ischemia, and dobutamine use increase AKI risk, leading to higher mortality and worsened renal function.

Area of Science:

  • Nephrology
  • Cardiology
  • Transplantation Medicine

Background:

  • Acute kidney injury (AKI) is a significant complication following heart transplantation.
  • Understanding perioperative risk factors and clinical outcomes of AKI is crucial for improving patient prognosis.

Purpose of the Study:

  • To identify perioperative risk factors associated with AKI after heart transplantation.
  • To evaluate the 1-year clinical outcomes, including mortality and renal function, in heart transplant recipients with and without AKI.

Main Methods:

  • Retrospective single-center cohort study including 209 heart transplant recipients from January 2015 to December 2020.
  • Multivariate logistic regression was used to identify independent risk factors for AKI.
  • Log-rank test compared 1-year survival between patients with and without AKI.

Main Results:

  • Post-transplantation AKI occurred in 64% of patients.
  • Independent risk factors for AKI included high body mass index (BMI), prolonged cold ischemic period, and high intraoperative dobutamine dose.
  • Patients with AKI had significantly higher 1-year mortality (20% vs. 8%) and 48% of survivors experienced worsened renal function.

Conclusions:

  • AKI is highly prevalent after heart transplantation and negatively impacts patient outcomes.
  • Identified risk factors (high BMI, prolonged cold ischemia, dobutamine) offer targets for preventive strategies.
  • Early identification and management of AKI risk factors are essential for improving long-term survival and renal function post-heart transplant.
Abstract

Keywords:
acute kidney injurycardiac surgerychronic kidney diseaseheart transplantation

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