Efficacy of Early Goal-directed Renal Replacement Therapy for the Treatment of Acute Kidney Injury after Heart Transplantation- A Single Center 10-Year Experience

Abstract Objective Acute kidney injury (AKI) after heart transplantation is a common and serious complication. We aim to evaluate the efficacy of early goal-directed renal replacement therapy (GDRRT) for the treatment of AKI after heart transplantation. Design This is a retrospective, observational study. Setting A Grade-A Tertiary hospital which performs more than 4000 cardiac surgery procedures per year. Participants Patients underwent heart transplantation with postoperative AKI and received renal replacement therapy from January 2008 to June 2018. Interventions Patients were divided into late GDRRT group (LGDRRT, January 2008∼September 2012) and early GDRRT group (EGDRRT, October 2012∼June 2018). Results There were 30 patients in LGDRRT group and 46 in EGDRRT group. Duration between surgery to RRT initiation in EGDRRT group was significantly shorter than in LGDRRT group (1[1, 3] vs. 2[2, 3] d, P=0.020). The in-hospital mortality in EGDRRT group was significantly lower than in LGDRRT group (39.1% vs. 63.3%, P=0.039). After multivariate adjustment for confounding factors, the HR for death in the LGDRRT group relative to the EGDRRT group was 2.028 (95% CI 1.072∼3.655, P=0.048). Length of ICU stay and hospital stay in EGDRRT group was significantly shorter than in LGDRRT group (26±18 vs. 38±20d, P=0.008;38±33 vs. 64±45d, P=0.005). Completely renal recovery rate was much higher than in EGDRRT group than in LGDRRT group (50.0% vs. 20.0%, P Conclusions For heart transplantation recipients with AKI, EGDRRT can reduced the in-hospital mortality and the length of ICU stay and hospital stay, improve the completely renal recovery rate, as well as reduce the cost of RRT.