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Incidence, Risk Factors and Outcomes of Early Acute Kidney Injury After Heart Transplantation: An 18-year Experience

García-Gigorro, Renata, MD, PhD1; Renes-Carreño, Emilio, MD1; Corres Peiretti, María Angélica, MD1; Arribas López, Primitivo, MD1; Perez Vela, Jose Luis, MD1; Gutierrez Rodríguez, Julián, MD1; Delgado, Juan Francisco, MD, PhD2,3; Cortina Romero, Jose María, MD4; Montejo González, Juan Carlos, MD, PhD5

doi: 10.1097/TP.0000000000002293
Original Clinical Science—General

Background Little is known about the incidence of acute kidney injury (AKI), as defined using the Kidney Disease Improving Global Outcome classification, after heart transplantation (HT). Our objective was to evaluate the impact of AKI in a cohort of HT recipients. (Setting: University Hospital.)

Methods We studied 310 consecutive HT recipients from 1999 to 2017, with AKI being defined according to the Kidney Disease Improving Global Outcome criteria. Risk factors were analyzed by multivariable analyses, and survival by Kaplan-Meier curves and a risk-adjusted Cox proportional hazards regression model.

Results One hundred twenty-five (40.3%) patients developed AKI, with 73 (23.5%), 18 (5.8%), and 34 (11%) patients having AKI stages 1, 2, and 3, respectively. Cardiac tamponade (odds ratio [OR], 16.82; 95% confidence interval [CI], 1.06-138), acute right ventricular failure (OR, 3.54; 95% CI, 1.82-6.88), and major bleeding (OR, 2.46; 95% CI, 1.18-5.1) were the principal risk factors for AKI. Patients with AKI had a greater hospital mortality (3.8% vs 16%, P < 0.05), especially those requiring renal replacement therapy (46.9% vs 5.4%, P = 0.006). Acute kidney injury requiring renal replacement therapy was independently associated with hospital mortality (OR, 11.03; 95% CI, 4.08-29.8). With a median follow-up after hospital discharge of 6.7 years (interquartile range, 2.4-11.6), overall survival at 1, 5, and 10 years was 95.4%, 85.1%, and 75.4% versus 85.2%, 69.8% and 63.5% among patients without AKI and with AKI stages 2 to 3, respectively (P = 0.08).

Conclusions The onset of AKI after HT is mainly associated with postoperative complications. Only severe AKI stage predicts worse short-term outcome, with this impact appearing to be lost at long-term follow-up.

The onset of acute kidney injury (AKI) after heart transplantation is mainly associated with postoperative complications, such as cardiac tamponade, acute right ventricular failure, and major bleeding and only severe AKI stage predicts worse short-term outcome.

1 Cardiac Intensive Care Unit Division, Intensive Care Medicine Department, Universitary Hospital “12 de Octubre”, Madrid, Spain.

2 Cardiology Department, Instituto de Investigación Sanitaria, Universitary Hospital “12 de Octubre” (imas12), Madrid, Spain.

3 CIBERCV, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.

4 Cardiovascular Surgery Department, Universitary Hospital “12 de Octubre”, Madrid, Spain.

5 Intensive Care Medicine Department, Universitary Hospital “12 de Octubre”, Madrid, Spain.

Received 25 January 2018. Revision received 18 April 2018.

Accepted 12 May 2018.

All authors of this research article have directly participated in the planning, execution, or analysis of this study.

The authors declare no funding or conflicts of interest.

R.G.G. has participated in the conception and design, literature search and in the writing of the paper. E.R.C. has participated in the data analysis and interpretation and in the final approval of the article. M.A.C.P. has participated in the critical revision of the article. P.A.L. has participated in data collection. J.G.R. has participated in data collection. J.L.P.-V. has participated in literature search. J.F.D. has participated in the critical revision of the article. J.M.C.-R. has participated in the provision of patients. J.C.M.-G. has participated in the provision of materials and resources.

Correspondence: Renata García Gigorro, MD, PhD, Intensive Care Medicine Department, Universitary Hospital “12 de Octubre”, Avenida de Córdoba, s/n, 28041, Madrid, Spain. (rennygg@hotmail.com).

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