title: Implications of acute kidney injury after heart transplantation: what a surgeon should know.
abstract: OBJECTIVE
  Data regarding risks and consequences of acute kidney injury (AKI) after cardiac transplantation are dismissingly few and unclear. This study defined the incidence, risk factors and prognostic implication of AKI in a single-center cohort operated on between January 1999 and December 2008.
  
  
  METHODS
  Data from 307 consecutive recipients (mean age: 47.42 ± 13.58, 20.5% female, 18.9% diabetics, 19.5% with previous cardiac operations, 26.4% hospitalized, 78.4 ± 33.7 ml min(-1) preoperative glomerular filtration rate (eGFR)) were analyzed using multivariable logistic regression modeling. AKI was defined according to RIFLE (Risk, Injury, and Failure; and Loss, and End-stage kidney disease) criteria.
  
  
  RESULTS
  RIFLE scores of I or F were detected in 14%, and continuous venovenous hemofiltration was needed in 6.1%. Risk factors for AKI were: previous cardiac operation (odds ratio (OR) 2.35; 95% confidence interval (CI), 1.11-4.9), blood transfusion (OR 1.08; 95% CI, 1.011-1.16), troponin I release >10 (OR 1.031; 95% CI, 1.001-1.064), length of ischemic time (OR 1.008; 95% CI, 1.011-1.16). Overall hospital mortality averaged 7.8% and overall 1-year mortality was 10.4%; both mortality rates increased with each RIFLE stratification (Normal 3.4%, RIFLE R = 7.1%; RIFLE I = 25.7%; and RIFLE F = 37.5% and Normal 5.6%, RIFLE R = 11.8%, RIFLE I = 25.7%, and RIFLE F = 37.5%, respectively). AKI proved independent predictors of both early and 1-year mortality. The burden of AKI significantly affected 1-year kidney function (Δ preoperative GFR-1-year GFR in AKI vs no AKI = -25.872 ± 22.54 vs -7.968 ± 34.18, p = 0.015).
  
  
  CONCLUSIONS
  AKI is a highly prevalent and prognostically important complication. Some of the risk factors for AKI identified may be modifiable.
authors.affiliation: Department of Cardiac Surgery, University of Foggia, Foggia, Italy. luca.desanto@ospedalemonaldi.it
authors.forename: Luca Salvatore
authors.initials: LS
authors.lastname: De Santo
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Romano
authors.forename: Cristiano
authors.initials: C
authors.lastname: Amarelli
authors.forename: Ciro
authors.initials: C
authors.lastname: Maiello
authors.forename: Francesco
authors.initials: F
authors.lastname: Baldascino
authors.forename: Ciro
authors.initials: C
authors.lastname: Bancone
authors.forename: Francesco
authors.initials: F
authors.lastname: Grimaldi
authors.forename: Gianantonio
authors.initials: G
authors.lastname: Nappi
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000503:physiopathology; D000328:Adult; D015415:Biomarkers / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology / Q000503:physiopathology; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011379:Prognosis; D019210:Troponin I / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D019210:Troponin I