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Abstract: TH-PO069

Assessment of the Nature of AKI Post Adult Orthotopic Heart Transplantation: A Single Tertiary Referral Center Experience

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Golbus, Ashley, Medical University of South Carolina College of Medicine, Charleston, South Carolina, United States
  • Quadri, Syed M.Z, Medical University of South Carolina Department of Medicine, Charleston, South Carolina, United States
  • McMahon, Blaithin A., Medical University of South Carolina Department of Medicine, Charleston, South Carolina, United States
Background

AKI is common following adult orthotopic heart transplantation (OHT) with rates ranging from 40.3% to 72.3%. AKI worsens 12-month survival with a subset of patients requiring kidney replacement therapy (KRT), developing ESRD, worsening CKD, or death. The purpose of our study was to assess the nature of AKI occurring post-adult OHT at the Medical University of South Carolina and to serve as a metric of how to best improve renal outcomes in this cohort of patients.

Methods

We analyzed AKI rates and renal outcomes in a cohort of 120 adult patients undergoing OHT at MUSC from 04/2015 to 04/2021. We investigated AKI incidence, severity, and timing; the effect of hemodilution on AKI I criteria; and KRT indication and initiation in a sub-cohort of AKI patients who required KRT (AKI-D patients). We investigated major adverse kidney events (MAKE) outcomes at 12-months post-OHT. We identified several risk factors for AKI and AKI-D and performed a univariate logistic regression analysis of risk factors.

Results

90% of patients met AKI criteria within 7 days post-OHT; 10% had no AKI, 48.3% had stage I AKI, 15.8% stage II, and 25.8% stage III. 31% of AKI stage I patients met criteria due to hemodilution. AKI criteria diagnosis was on median day 1 post-OHT. Median initiation of KRT was POD2 for the predominant indication of volume overload. Of AKI-D patients, MAKE criteria was assessed at 12 months post-OHT and showed 74.2% (n=23) of patients had doubling SCr, 16.2% (n=5) were ESRD, and 19.4% (n=6) died. Significant risk factors for AKI included CPB time (OR: 1.007, 95% CI: 1.001-1.013; P=0.015), VIS score (OR: 1.041, 95% CI: 1.011-1.072; P=0.007), preoperative SCr (OR: 5.61, 95% CI: 2.397-13.133; P<0.001), primary graft dysfunction (OR: 8.546, 95% CI: 2.705-26.994; P<0.001), and RV failure (OR: 5.548, 95% CI: 2.263-12.606; P<0.001).

Conclusion

AKI is a common finding post-OHT, however the majority of the AKI in this cohort of patients was AKI stage I. We identified that any AKI was associated with poor renal outcomes such as MAKE-12 months. Timing of all stages of AKI suggests etiologies such as RV failure and graft dysfunction as major risk factors for AKI.