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Abstract: TH-PO043

Reduction of Intra-Operative Nephrotoxic Antimicrobial Exposure Can Improve Renal Recovery in Patients Undergoing Heart Transplantation

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

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

Acute Kidney Injury (AKI) is very common complication after orthotropic heart transplant (OHT) with reported incidence of approximately 40-70%. Antibiotics, particularly Piperacillin-tazobactam and vancomycin (VPT) combination has been associated with 3-fold increased hazard ratio for AKI. We hypothesized that reducing the exposure of intra-operative nephrotoxic antimicrobial medication exposure may result in lower rates of AKI after OHT.

Methods

Single-center, prospective, non-randomized, open-label observation study was performed at Medical University of South Carolina (MUSC) between 04/2015 to 04/2021. We introduced an intra-operative protocol change from VPT to cefepime and vancomycin (VC) use. 48 patients undergoing adult OHT received intra-operative VPT between 04/2015-05/2019, labelled as pre-intervention arm. 72 patients undergoing OHT between 05/2019-04/2021 received intra-operative VC, labelled as post-intervention arm. AKI was defined as per KDIGO 2012 criteria. Renal recovery was defined as 25% improvement in serum creatinine within 7 days of surgery without kidney replacement therapy (KRT) or KRT cessation in those requiring KRT. Major adverse kidney events (MAKE) were assessed at hospital discharge and 12-months. A p-value of less than 0.05 was considered significant

Results

Rates of all stages of KDIGO AKI and rates of RRT remained the same after the intervention. The rates of renal recovery prior to hospital discharge improved 3.8-fold in the post-intervention group (79.3% vs 44.4 %, P<0.05). All patients who required KRT in pre-intervention group did not recover at one-week post-OHT (0% vs 31.25%, P < 0.05). MAKE were less in post-intervention group at hospital discharge (p<0.05). 27% of blood cultures were positive in pre-interventional arm compared to 22% in post-interventional arm (p=0.66). There was no positive enterococcal blood culture in post-interventional arm

Conclusion

Our results suggest that high doses of VPT combination lead to poor AKI recovery rates and significant MAKE at hospital discharge in OHT patients as compared to VC. Though this results in loss of enterococcal coverage, none of the patients grew enterococcal species in blood cultures. The mechanism by which the combination VPT contributes to poor renal recovery requires further research.