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Acute Kidney Injury After Heart Transplant: The Importance of Pulmonary Hypertension.
Bianco, Juan C; Stang, María V; Denault, André Y; Marenchino, Ricardo G; Belziti, César A; Musso, Carlos G.
Afiliación
  • Bianco JC; Department of Anesthesiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. Electronic address: juan.bianco@hospitalitaliano.org.ar.
  • Stang MV; Department of Anesthesiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
  • Denault AY; Department of Anesthesiology and Intensive Care Medicine, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada.
  • Marenchino RG; Department of Cardiovascular Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
  • Belziti CA; Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
  • Musso CG; Department of Nephrology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Facultad de Ciencias de la Salud. Universidad Simón Bolivar, Barranquilla, Colombia.
J Cardiothorac Vasc Anesth ; 35(7): 2052-2062, 2021 Jul.
Article en En | MEDLINE | ID: mdl-33414071
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 MAIN RESULTS: 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, p = 0.028), central venous-to-pulmonary capillary wedge pressure ratio ≥0.86 (OR: 3.59, 95% CI: 1.13-11.43, p = 0.030), and postoperative right ventricular dysfunction (OR: 3.63, 95% CI: 1.50-8.75, p = 0.004). Conversely, preoperative estimated glomerular filtration rate (OR: 0.99, 95% CI: 0.97-1.00, p = 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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trasplante de Corazón / Lesión Renal Aguda / Hipertensión Pulmonar Tipo de estudio: Diagnostic_studies / Etiology_studies / Observational_studies / Risk_factors_studies Límite: Adult / Humans Idioma: En Revista: J Cardiothorac Vasc Anesth Asunto de la revista: ANESTESIOLOGIA / CARDIOLOGIA Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trasplante de Corazón / Lesión Renal Aguda / Hipertensión Pulmonar Tipo de estudio: Diagnostic_studies / Etiology_studies / Observational_studies / Risk_factors_studies Límite: Adult / Humans Idioma: En Revista: J Cardiothorac Vasc Anesth Asunto de la revista: ANESTESIOLOGIA / CARDIOLOGIA Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos