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

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          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 m 2 [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.

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          Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients.

          Richard W.F. Cheng, Rory Hachamovitch, Michelle Kittleson … (2014)
          Venoarterial extracorporeal membrane oxygenation (ECMO) has been used successfully for treatment of cardiogenic shock or cardiac arrest. The exact complication rate is not well understood, in part because of small study sizes. In the absence of large clinical trials, performance of pooled analysis represents the best method for ascertaining complication rates for ECMO.
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            Renal replacement therapy in critically ill patients receiving extracorporeal membrane oxygenation.

            David J. Askenazi, David T Selewski, Matthew L Paden … (2012)
            Extracorporeal membrane oxygenation (ECMO) is a lifesaving procedure used in neonates, children, and adults with severe, reversible, cardiopulmonary failure. On the basis of single-center studies, the incidence of AKI occurs in 70%-85% of ECMO patients. Those with AKI and those who require renal replacement therapy (RRT) are at high risk for mortality, independent of potentially confounding variables. Fluid overload is common in ECMO patients, and is one of the main indications for RRT. RRT to maintain fluid balance and metabolic control is common in some but not all centers. RRT on ECMO can be performed via an in-line hemofilter or by incorporating a standard continuous renal replacement machine into the ECMO circuit. Both of these methods require specific technical considerations to provide safe and effective RRT. This review summarizes available epidemiologic data and how they apply to our understanding of AKI pathophysiology during ECMO, identifies indications for RRT while on ECMO, reviews technical elements for RRT application in the setting of ECMO, and finally identifies specific research-focused questions that need to be addressed to improve outcomes in this at-risk population.
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              Lessons from the crystallographic analysis of small molecule binding to human serum albumin.

              Stephen Curry (2009)
              Human serum albumin (HSA) is an abundant and highly soluble plasma protein with the capacity to bind a remarkably diverse set of lipophilic anionic compounds so that it fulfils important roles in the transport of nutrients, hormones and toxins. The protein attracts great interest from the pharmaceutical industry since it can also bind a variety of drug molecules, impacting their delivery and efficacy. Our understanding of the binding and transport properties of albumin has been transformed by structural studies of the protein, in which crystallographic analysis has played a leading role. This review summarises the main insights to have accrued from this work, highlighting the significant advances that have been made but also pointing out some of the challenges ahead. Since further progress is likely to benefit from increased structural scrutiny of HSA, methodological developments instrumental to the success of crystallographic analysis of the protein are discussed in some detail.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Transl Med
                Journal ID (iso-abbrev): Ann Transl Med
                Journal ID (publisher-id): ATM
                Title: Annals of Translational Medicine
                Publisher: AME Publishing Company
                ISSN (Print): 2305-5839
                ISSN (Electronic): 2305-5847
                Publication date (Print and electronic): March 2022
                Publication date (Print): March 2022
                Volume: 10
                Issue: 5
                Electronic Location Identifier: 257
                Affiliations
                [1 ]deptDepartment of Nephrology, Guangdong Provincial People’s Hospital , Guangdong Academy of Medical Sciences , Guangzhou, China;
                [2 ]Shantou University Medical College , Shantou, China;
                [3 ]deptSchool of Medicine , South China University of Technology , Guangzhou, China;
                [4 ]deptDepartment of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital , Guangdong Academy of Medical Sciences , Guangzhou, China;
                [5 ]deptThe Second School of Clinical Medicine , Southern Medical University , Guangzhou, China;
                [6 ]deptHeart Transplantation and VAD Division, Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital , Guangdong Academy of Medical Sciences , Guangzhou, China
                Author notes

                Contributions: (I) Conception and design: B Xie, L Fu, Z Ye, X Liang; (II) Administrative support: Z Ye, X Liang, M Wu, C Zhou, J Huang; (III) Provision of study materials or patients: B Xie, L Fu, Z Ye, X Liang, M Wu, Y Wu, C Zhou, J Huang; (IV) Collection and assembly of data: B Xie, L Fu, X Xie, W Zhang, J Hou, D Liu; (V) Data analysis and interpretation: B Xie, L Fu, L Zhang, R Li, X Xie, W Zhang, J Hou, D Liu; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

                [#]

                These authors contributed equally to this work.

                Correspondence to: Zhiming Ye. Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China. Email: yezhiming@ 123456gdph.org.cn ; Min Wu. Heart Transplantation and VAD Division, Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China. Email: wumin0011@ 123456gdph.org.cn .
                Article
                Publisher ID: atm-10-05-257
                DOI: 10.21037/atm-22-541
                PMC ID: 8987878
                PubMed ID: 35402585
                SO-VID: bc77e316-9b98-4171-aae7-5b09f8356c48
                Copyright © 2022 Annals of Translational Medicine. All rights reserved.
                License:

                Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

                History
                Date received : 07 January 2022
                Date accepted : 04 March 2022
                Categories
                Subject: Original Article

                Keywords: heart transplantation (ht),acute kidney injury (aki),renal replacement therapy (rrt)
                Data availability:
                Keywords: heart transplantation (ht), acute kidney injury (aki), renal replacement therapy (rrt)

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