Tissue Perfusion Pressure as a Physiologic Indicator of Renal Failure Risk After Heart Transplantation

Area of Science:

• Cardiology
• Nephrology
• Transplantation Medicine

Background:

• Mean arterial pressure (MAP) is standard for hemodynamic management post-heart transplant.
• Renal failure remains a significant complication despite MAP monitoring.
• Tissue perfusion pressure (TPP) shows promise in predicting acute kidney injury.

Purpose of the Study:

• To investigate if postoperative TPP predicts the need for continuous renal replacement therapy (CRRT) after heart transplantation.
• To compare the predictive performance of TPP against MAP and organ perfusion pressure (OPP).

Main Methods:

• Retrospective analysis of adult heart transplant recipients (01/2020-06/2025).
• Exclusion of multiorgan transplants, congenital heart disease, and ECMO support.
• Hourly analysis of TPP, MAP, and OPP for 72 hours post-transplant.
• Stratification based on CRRT requirement and comparison using net reclassification improvement (NRI).

Main Results:

• 47 out of 269 patients (17.5%) required CRRT.
• CRRT patients had higher rates of circulatory death donors and pre-transplant creatinine.
• Lower median and mean TPP, OPP, and MAP observed in the CRRT group.
• Early postoperative TPP demonstrated superior prediction of CRRT compared to MAP and OPP (NRI 0.49 vs 0.39).

Conclusions:

• Early postoperative TPP is an independent predictor of CRRT necessity after heart transplantation.
• TPP offers superior risk reclassification for kidney injury compared to traditional hemodynamic metrics.
• TPP may enhance hemodynamic management strategies to prevent renal failure post-transplant.