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Kidney Week

Abstract: FR-PO043

The Role of Perioperative Renal Replacement Therapy in Heart Transplantation

Session Information

  • AKI: Clinical Outcomes, Trials
    November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Lee, Sua, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea (the Republic of)
  • Chung, Byung ha, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea (the Republic of)
  • Choi, Bumsoon, Eunpyeong St. Mary's Hospital, Seoul, SEOUL, Korea (the Republic of)
  • Park, Cheol Whee, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea (the Republic of)
  • Yang, Chul Woo, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea (the Republic of)
  • Ban, Tae Hyun, Eunpyeong St. Mary's Hospital, Seoul, SEOUL, Korea (the Republic of)
Background

Heart transplantation (HT) is the treatment of choice for patients with end-stage heart failure. Although several studies had reports about association with acute kidney injury (AKI) and HT, little is known about the impact of perioperative renal replacement therapy (RRT) on clinical outcomes of HT. We compared the clinical characteristics and outcome of patients according to RRT at the time of HT.

Methods

A total of 23 patients were underwent heart transplantation from January 1995 to May 2019 at Seoul St. Mary’s hospital and Eunpyeong St. Mary’s hospital. The most recent patient was excluded because of the short follow-up duration. We reviewed data including the cause of heart failure, cardiac function and renal function based on electronic medical records. The patients were divided as heart transplant recipients (HTRs) who underwent perioperative RRT (RRT group, n=9) and HTRs who did not received RRT (non-RRT group, n=14). Renal function was analyzed at baseline, 1 month, 3 months, 6 months and 12 months after HT.

Results

The most common cause of HT was dilated cardiomyopathy (n=11, 50%), then followed by ischemic cardiomyopathy (n=8, 36%). The LVEF before HT in the RRT group was significantly lower than that of the non-RRT group (LVEF 15.2 % vs 24.8%, P=0.014, respectively). In the RRT group, six patients (27.6%) underwent RRT before HT including with five patients of continuous renal replacement therapy (CRRT) and a patient of peritoneal dialysis. Finally, eight patients (36.4%) received RRT before and after HT, including five patients who initiated RRT prior to transplantation. After 1 month and 6 months post-transplantation, the renal function of RRT group were significantly worse than that of non-RRT patients (eGFR 40.95 vs 63.48 ml/min/1.73m2, p=0.031, after 1 month; 39.40 vs 71.01 ml/min/1.73m2, p=0.011, after 6 months). However, after 12 months post-transplantation, there was no significant difference of renal function between RRT group and non-RRT groups (eGFR 54.98 vs 68.30 ml/min/1.73m2, p=0.294). All the patients in the RRT group were tolerated without dialysis after HT.

Conclusion

RRT at the perioperative period in the heart transplant recipients will be a good bridge therapy for recovery of renal function in the cases with a high risk of cardiorenal AKI with low LVEF.