Risk factors of renal replacement therapy after heart transplantation: a retrospective single-center study

Bingying Xie; Lei Fu; Yijin Wu; Xinfu Xie; Wenhao Zhang; Jihua Hou; Dinglin Liu; Ruizhao Li; Li Zhang; Chengbin Zhou; Jinsong Huang; Xinling Liang; Min Wu; Zhiming Ye

doi:10.21037/atm-22-541

Risk factors of renal replacement therapy after heart transplantation: a retrospective single-center study

Ann Transl Med. 2022 Mar;10(5):257. doi: 10.21037/atm-22-541.

Authors

Bingying Xie^#^{1

2}, Lei Fu^#^{1

3}, Yijin Wu⁴, Xinfu Xie^{1

5}, Wenhao Zhang^{1

2}, Jihua Hou^{1

5}, Dinglin Liu^{1

3}, Ruizhao Li¹, Li Zhang¹, Chengbin Zhou⁶, Jinsong Huang⁶, Xinling Liang^{1

3}, Min Wu⁶, Zhiming Ye^{1

5}

Affiliations

¹ Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² Shantou University Medical College, Shantou, China.
³ School of Medicine, South China University of Technology, Guangzhou, China.
⁴ Department of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁵ The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
⁶ Heart Transplantation and VAD Division, Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

^# Contributed equally.

Abstract

Background: Acute kidney injury (AKI) and renal replacement therapy (RRT) are common after heart transplantation (HT). The need for RRT has been reported to be one of the most important predictors of a poor prognosis after HT. Therefore, it is important to early identify risk factors of RRT after HT. However, in the heart transplantation setting, the risk factors are less well studied, and some of the conclusions are controversial. This study aimed to identify the clinical predictors of RRT after HT.

Methods: This single-center, retrospective study from January 2010 to June 2021 analyzed risk factors (pre-, intra-, and postoperative characteristics) of 163 patients who underwent HT. The endpoint of the study was RRT within 7 days of HT. Risk factors were analyzed by multivariable logistic regression models.

Results: Fifty-five (33.74%) recipients required RRT within 7 days of HT. Factors independently associated with RRT after HT were as follows: a baseline estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m² [odds ratio (OR) =3.123; 95% confidence interval (CI): 1.183-8.244; P=0.022], a dose of intraoperative methylprednisolone >10 mg/kg (OR =3.197; 95% CI: 1.290-7.923; P=0.012), the use of mechanical circulatory support (MCS) during surgery (OR =4.903; 95% CI: 1.628-14.766; P=0.005), a cardiopulmonary bypass (CPB) time ≥5 hours (OR =3.929; 95% CI: 1.222-12.634; P=0.022), and postoperative serum total bilirubin (TBIL) ≥60 umol/L (OR =5.105; 95% CI: 1.868-13.952; P=0.001). Protective factors were higher postoperative serum albumin (OR =0.907; 95% CI: 0.837-0.983; P=0.017) and higher postoperative left ventricular ejection fraction (LVEF) (OR =0.908; 95% CI: 0.838-0.985; P=0.020).

Conclusions: A low preoperative eGFR, a high intraoperative dose of methylprednisolone, a long CPB time, the use of mechanical circulatory support, and a high postoperative TBIL were risk factors for RRT after HT. While a high postoperative serum albumin level and a high left ventricular ejection fraction were protective factors. Understanding these risk factors may help us identify high-risk patients and intervene early.

Keywords: Heart transplantation (HT); acute kidney injury (AKI); renal replacement therapy (RRT).