Acute Kidney Injury After Heart Transplantation: Risk Factors and Clinical Outcomes

OBJECTIVEAcute kidney injury (AKI) requiring renal replacement therapy (RRT) after heart transplantation (OHT) is common and impairs outcomes. This study aimed to identify independent donor and recipient risk factors associated with RRT after OHT.DESIGNRetrospective data analysis.SETTINGThe data were collected from clinical routines in a maximum care university hospital.PARTICIPANTSPatients who underwent OHTINTERVENTIONSThe authors retrospectively analyzed data from 264 patients who underwent OHT between 2012 and 2021. 189 patients were eligible and included in the final analysis.MEASUREMENTS AND MAIN RESULTSThe mean age was 48.0 ± 12.3 years. 71.4% were male. 90 (47.6%) were on long-term mechanical circulatory support (lt-MCS). Post-transplant AKI with RRT occurred in 123 (65.1%) patients. In a multivariate analysis, preoperative BMI >25kg/m² (OR 4.74, p<0.001), elevated preoperative creatinine levels (OR for each mg/dl increase 3.44, p=0.004), administration of red blood cell units during transplantation procedure (OR 2.31, p=0.041) and ischemia time (OR for each hour increase 1.77, p=0.004) were associated with a higher incidence of RRT. The use of renin–angiotensin–aldosterone system blockers prior to transplantation was associated with a reduced risk of RRT (OR 0.36, p=0.013). The risk of mortality was 6.9-fold higher in patients who required RRT (HR 6.9, 95% CI: 2.1-22.6 p=0.001). Previous lt-MCS as well as donor parameters were not associated with RRT after OHT.CONCLUSIONSImplementation of guideline-directed medical therapy, weight reduction, minimizing ischemia time (i.e. organ perfusion systems, workflow optimization), and a comprehensive patient blood management potentially influences renal function and outcomes after OHT.