Risk factors for acute kidney injury requiring renal replacement therapy after orthotopic heart transplantation in patients with preserved renal function

René M‘pembele, Sebastian Roth, Alexandra Stroda, Giovanna Lurati Buse, Stephan U. Sixt, Ralf Westenfeld, Amin Polzin, Philipp Rellecke, Igor Tudorache, Markus W. Hollmann, Hug Aubin, Payam Akhyari, Artur Lichtenberg, Ragnar Huhn, Udo Boeken

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2 Citations (Scopus)

Abstract

Acute kidney injury (AKI), requiring renal replacement therapy (RRT). is a serious complication after orthotopic heart transplantation (HTX). In patients with preexisting impaired renal function, postoperative AKI is unsurprising. However, even in patients with preserved renal func-tion, AKI requiring RRT is frequent. Therefore, this study aimed to identify risk factors associated with postoperative AKI requiring RRT after HTX in this sub-cohort. This retrospective cohort study included patients ≥18 years of age with preserved renal function (defined as preoperative glomerular filtration rate ≥60 mL/min) who underwent HTX between 2010 and 2021. In total, 107 patients were included in the analysis (mean age 52 ± 12 years, 78.5% male, 45.8% AKI requiring RRT). Based on univariate logistic regression, use of extracorporeal membrane oxygenation, postoperative infec-tion, levosimendan therapy, duration of norepinephrine (NE) therapy and maximum daily increase in tacrolimus plasma levels were chosen to be included into multivariate analysis. Duration of NE therapy and maximum daily increase in tacrolimus plasma levels remained as independent signif-icant risk factors (NE: OR 1.01, 95%CI: 1.00–1.02, p = 0.005; increase in tacrolimus plasma level: OR 1.18, 95%CI: 1.01–1.37, p = 0.036). In conclusion, this study identified long NE therapy and maximum daily increase in tacrolimus plasma levels as risk factors for AKI requiring RRT in HTX patients with preserved renal function.
Original languageEnglish
Article number4117
JournalJournal of Clinical Medicine
Volume10
Issue number18
DOIs
Publication statusPublished - 1 Sep 2021

Keywords

  • Calcineurin inhibitors
  • Cardiac surgery
  • Heart failure
  • Prognosis
  • Tacrolimus
  • Vasopressors

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