Correlation between blood transfusion and postoperative acute kidney injury after heart transplantation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZENG Xiaodong , LEI Liming , XIONG Weiping , WU Yijin , HUANG Jingsong , ZHUANG Jian ,  CHEN Jimei , ZHU Weizhong , LUO Dandong

Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People’s Hospital, Guangzhou, 510080, P.R.China;

Corresponding author：

CHEN Jimei, Email: jimei1965@gmail.com

Keywords：

Heart transplantation; blood transfusion; acute kidney injury; renal replacement therapy

DOI：

10.7507/1007-4848.201909006

Video：

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Objective To explore the correlation between perioperative blood transfusion and acute kidney injury (AKI) after heart transplantation.Methods A retrospective study was performed on 67 patients who underwent heart transplantation in the Department of Cardiac Surgery, Guangdong Provincial People's Hospital from January 2016 to December 2018, and finally 63 patients were included according to the exclusion criteria. There were 53 males and 10 females with an average age of 44.3±12.9 years. Twenty patients who adopted continuous renal replacement therapy (CRRT) after heart transplantation were divided into a RT group and the other 43 patients who did not use CRRT were divided into a non-RT group. Baseline characteristics, perioperative blood transfusion data and clinical prognosis were compared between the two groups.Results The preoperative baseline characteristics of the two groups were basically the same. There were significant differences in perioperative infusion of red blood cells and plasma, postoperative 24 h bleeding and re-exploration (P<0.05) between the two groups. The area under the receiver operating characteristic (ROC) curve was 0.923 (95%CI 0.852 to 0.995, P<0.001). The ROC curve showed that perioperative infusion of red blood cells more than 18 mL/kg would increase the incidence of AKI after heart transplantation.Conclusion Perioperative blood transfusion is closely related to AKI after heart transplantation. The more blood transfusion is in clinics, the higher incidence of renal injury is and the worse prognosis is. It is suggested that various blood-saving measures can be carried out.

Citation： ZENG Xiaodong, LEI Liming, XIONG Weiping, WU Yijin, HUANG Jingsong, ZHUANG Jian, CHEN Jimei, ZHU Weizhong, LUO Dandong. Correlation between blood transfusion and postoperative acute kidney injury after heart transplantation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(4): 426-430. doi: 10.7507/1007-4848.201909006 Copy

1.	Fortrie G, Manintveld OC, Caliskan K, et al. Acute kidney injury as a complication of cardiac transplantation: incidence, risk factors, and impact on 1-year mortality and renal function. Transplantation, 2016, 100(8): 1740-1749.
2.	García-Gigorro R, Renes-Carreño E, Corres Peiretti MA, et al. Incidence, risk factors and outcomes of early acute kidney injury after heart transplantation: an 18-year experience. Transplantation, 2018, 102(11): 1901-1908.
3.	Ivey-Miranda JB, Flores-Umanzor E, Farrero-Torres M, et al. Predictors of renal replacement therapy after heart transplantation and its impact on long-term survival. Clin Transplant, 2018, 32(10): e13401.
4.	Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract, 2012, 120(4): c179-c184.
5.	Vlot EA, Verwijmeren L, van de Garde EMW, et al. Intra-operative red blood cell transfusion and mortality after cardiac surgery. BMC Anesthesiol, 2019, 19(1): 65.
6.	Karkouti K, Wijeysundera DN, Yau TM, et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation, 2009, 119(4): 495-502.
7.	Parreiras VC, Rocha Ide S, Martins AS, et al. Influence of fresh frozen plasma as a trigger factor for kidney dysfunction in cardiovascular surgery. Rev Bras Cir Cardiovasc, 2012, 27(3): 405-410.
8.	Khan H, Belsher J, Yilmaz M, et al. Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients. Chest, 2007, 131(5): 1308-1314.
9.	Kindzelski BA, Corcoran P, Siegenthaler MP, et al. Postoperative acute kidney injury following intraoperative blood product transfusions during cardiac surgery. Perfusion, 2018, 33(1): 62-70.
10.	Merchant AM, Neyra JA, Minhajuddin A, et al. Packed red blood cell transfusion associates with acute kidney injury after transcatheter aortic valve replacement. BMC Anesthesiol, 2019, 19(1): 99.
11.	Freeland K, Hamidian Jahromi A, Duvall L, et al. Postoperative blood transfusion is an independent predictor of acute kidney injury in cardiac surgery patients. J Nephropathol, 2015, 4(4): 121-126.
12.	Koch CG, Li L, Sessler DI, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med, 2008, 358(12): 1229-1239.
13.	Obrador R, Musulin S, Hansen B. Red blood cell storage lesion. J Vet Emerg Crit Care, 2015, 25(2): 187-199.
14.	Bishnoi A, Garg P, Patel K, et al. Effect of red blood cell storage duration on outcome after paediatric cardiac surgery: a prospective observational study. Heart Lung Circ, 2019, 28(5): 784-791.
15.	Haase M, Haase-Fielitz A, Bellomo R. Cardiopulmonary bypass, hemolysis, free iron, acute kidney injury and the impact of bicarbonate. Contrib Nephrol, 2010, 165: 28-32.
16.	Qian Q, Nath KA, Wu Y, et al. Hemolysis and acute kidney failure. Am J Kidney Dis, 2010, 56(4): 780-784.
17.	Mamikonian LS, Mamo LB, Smith PB, et al. Cardiopulmonary bypass is associated with hemolysis and acute kidney injury in neonates, infants, and children. Pediatr Crit Care Med, 2014, 15(3): e111-e119.
18.	Karkouti K. Transfusion and risk of acute kidney injury in cardiac surgery. Br J Anaesth, 2012, 109 Suppl 1: i29-i38.
19.	Nam K, Jang EJ, Kim GH, et al. Perioperative red blood cell transfusion and mortality following heart transplantation: a retrospective nationwide population‐based study between 2007 and 2016 in Korea. J Card Surg, 2019, 34(10): 927-932.
20.	Garg AX, Badner N, Bagshaw SM, et al. Safety of a restrictive versus liberal approach to red blood cell transfusion on the outcome of aki in patients undergoing cardiac surgery: a randomized clinical trial. J Am Soc Nephrol, 2019, 30(7): 1294-1304.

1. Fortrie G, Manintveld OC, Caliskan K, et al. Acute kidney injury as a complication of cardiac transplantation: incidence, risk factors, and impact on 1-year mortality and renal function. Transplantation, 2016, 100(8): 1740-1749.
2. García-Gigorro R, Renes-Carreño E, Corres Peiretti MA, et al. Incidence, risk factors and outcomes of early acute kidney injury after heart transplantation: an 18-year experience. Transplantation, 2018, 102(11): 1901-1908.
3. Ivey-Miranda JB, Flores-Umanzor E, Farrero-Torres M, et al. Predictors of renal replacement therapy after heart transplantation and its impact on long-term survival. Clin Transplant, 2018, 32(10): e13401.
4. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract, 2012, 120(4): c179-c184.
5. Vlot EA, Verwijmeren L, van de Garde EMW, et al. Intra-operative red blood cell transfusion and mortality after cardiac surgery. BMC Anesthesiol, 2019, 19(1): 65.
6. Karkouti K, Wijeysundera DN, Yau TM, et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation, 2009, 119(4): 495-502.
7. Parreiras VC, Rocha Ide S, Martins AS, et al. Influence of fresh frozen plasma as a trigger factor for kidney dysfunction in cardiovascular surgery. Rev Bras Cir Cardiovasc, 2012, 27(3): 405-410.
8. Khan H, Belsher J, Yilmaz M, et al. Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients. Chest, 2007, 131(5): 1308-1314.
9. Kindzelski BA, Corcoran P, Siegenthaler MP, et al. Postoperative acute kidney injury following intraoperative blood product transfusions during cardiac surgery. Perfusion, 2018, 33(1): 62-70.
10. Merchant AM, Neyra JA, Minhajuddin A, et al. Packed red blood cell transfusion associates with acute kidney injury after transcatheter aortic valve replacement. BMC Anesthesiol, 2019, 19(1): 99.
11. Freeland K, Hamidian Jahromi A, Duvall L, et al. Postoperative blood transfusion is an independent predictor of acute kidney injury in cardiac surgery patients. J Nephropathol, 2015, 4(4): 121-126.
12. Koch CG, Li L, Sessler DI, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med, 2008, 358(12): 1229-1239.
13. Obrador R, Musulin S, Hansen B. Red blood cell storage lesion. J Vet Emerg Crit Care, 2015, 25(2): 187-199.
14. Bishnoi A, Garg P, Patel K, et al. Effect of red blood cell storage duration on outcome after paediatric cardiac surgery: a prospective observational study. Heart Lung Circ, 2019, 28(5): 784-791.
15. Haase M, Haase-Fielitz A, Bellomo R. Cardiopulmonary bypass, hemolysis, free iron, acute kidney injury and the impact of bicarbonate. Contrib Nephrol, 2010, 165: 28-32.
16. Qian Q, Nath KA, Wu Y, et al. Hemolysis and acute kidney failure. Am J Kidney Dis, 2010, 56(4): 780-784.
17. Mamikonian LS, Mamo LB, Smith PB, et al. Cardiopulmonary bypass is associated with hemolysis and acute kidney injury in neonates, infants, and children. Pediatr Crit Care Med, 2014, 15(3): e111-e119.
18. Karkouti K. Transfusion and risk of acute kidney injury in cardiac surgery. Br J Anaesth, 2012, 109 Suppl 1: i29-i38.
19. Nam K, Jang EJ, Kim GH, et al. Perioperative red blood cell transfusion and mortality following heart transplantation: a retrospective nationwide population‐based study between 2007 and 2016 in Korea. J Card Surg, 2019, 34(10): 927-932.
20. Garg AX, Badner N, Bagshaw SM, et al. Safety of a restrictive versus liberal approach to red blood cell transfusion on the outcome of aki in patients undergoing cardiac surgery: a randomized clinical trial. J Am Soc Nephrol, 2019, 30(7): 1294-1304.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Correlation between blood transfusion and postoperative acute kidney injury after heart transplantation

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