Predictive Value of Right Heart Hemodynamics for Acute Kidney Injury After Heart Transplantation

G. Guven, M. Brankovic, A.A. Constantinescu, J.J. Brugts, D.A. Hesselink, S. Akin, A. Struijs, O. Birim, C. Ince, O.C. Manintveld, K. Caliskan

Thursday 15 march 2018

12:50 - 13:00h at Van Rijck/Ruys Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 5: Clinical

Background

Acute kidney injury (AKI) is a serious complication after heart transplantation (HTx), but its relation with preoperative right heart hemodynamics (RHH) remains unknown. The aim of the study is to determine whether listing RHH predict severity of AKI early after HTx, and to investigate the effect of AKI stages on 1-year survival.

Methods

In 595 HTx adult recipients, we evaluated preoperative RHH and the occurrence of AKI stages during the first postoperative. Pulmonary artery pulsatility index (PAPi), trans-pulmonary gradient (TPG), and diastolic pulmonary gradient (DPG) were calculated as composite parameters.

Results

AKI was developed in 430 (72%), including 278 (47%) stage-1, 11% (n=66) stage-2, and 14% (n=86) stage-3. Renal replacement therapy (RRT) was needed in 41 patients (7%), with high risk for chronic RRT-dependency at 1-year (odds ratio: 3.3 [95% CI: 1.6–6.6], p=0.001). Patients with higher AKI stages had higher baseline RAP (median: 7, 7, 8, 11 mmHg, p-trend=0.021), RAP/PCWP ratio (0.37, 0.36, 0.40, 0.47 p-trend=0.009), and lower PAPi values (2.83, 3.17, 2.54, 2.31 p-trend=0.012).When RAP ≥6mmHg, RAP and PAPi were associated with severity of AKI independently of preoperative creatinine levels, urgency status, preoperative hemodynamic support, postoperative complications and induction therapy (per doubling, RAP: 1.47 [1.04–2.09] p=0.031, PAPi: 0.77 [0.62–0.97] p=0.026). Patients with higher AKI stages had significantly lower survival at 1-year (5, 7, 15, 14%, log-rank, p-trend=0.021) with worst outcome for RRT patients (1-year mortality RRT: 22% vs. no-RRT: 8%, log-rank, p=0.001).

Conclusions

AKI is a highly frequent after HTx and is inversely associated with 1-year patient survival. The routinely collected preoperative PAPi and RAP predict the severity of AKI early after HTx and can be used as early AKI predictors.