Acute Kidney Injury After Heart Transplant: The Importance of Pulmonary Hypertension.
J Cardiothorac Vasc Anesth
; 35(7): 2052-2062, 2021 Jul.
Article
em En
| MEDLINE
| ID: mdl-33414071
ABSTRACT
OBJECTIVE:
To determine whether relative pulmonary hypertension (PH), defined as the ratio of mean arterial pressure to mean pulmonary artery pressure, is associated with severe acute kidney injury (AKI) after heart transplant (HT).DESIGN:
An institutional review board-approved retrospective observational study.SETTING:
Tertiary care university hospital.PARTICIPANTS:
A total of 184 consecutive adult patients who underwent HT between January 2009 and December 2017 were included, and were followed up through December 2019. Using the Kidney Disease Improving Global Outcomes classification, recipients were categorized into two groups patients who developed stage 3 AKI (severe AKI) and those with minor or without AKI (nonsevere AKI) within seven days after transplant.INTERVENTIONS:
None. MEASUREMENTS AND MAINRESULTS:
Of the included patients, 83.2% developed AKI, in whom 40.8%, 19.6%, and 22.8% were stage 1, 2, and 3, respectively. With use of the multivariate logistic regression analysis, independent risk factors for stage 3 AKI post-HT included preoperative relative PH (odds ratio [OR] 1.62, 95% confidence interval [95% CI] 1.05-2.49, pâ¯=â¯0.028), central venous-to-pulmonary capillary wedge pressure ratio ≥0.86 (OR 3.59, 95% CI 1.13-11.43, pâ¯=â¯0.030), and postoperative right ventricular dysfunction (OR 3.63, 95% CI 1.50-8.75, pâ¯=â¯0.004). Conversely, preoperative estimated glomerular filtration rate (OR 0.99, 95% CI 0.97-1.00, pâ¯=â¯0.143) was not related to the development of stage 3 AKI post-HT.CONCLUSIONS:
Preoperative relative PH, central venous-to-pulmonary capillary wedge pressure ratio, and postoperative right ventricular failure by echocardiographic assessment were associated with severe AKI post-HT.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Transplante de Coração
/
Injúria Renal Aguda
/
Hipertensão Pulmonar
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
Limite:
Adult
/
Humans
Idioma:
En
Revista:
J Cardiothorac Vasc Anesth
Assunto da revista:
ANESTESIOLOGIA
/
CARDIOLOGIA
Ano de publicação:
2021
Tipo de documento:
Article