title: Aprotinin, transfusions, and kidney injury in neonates and infants undergoing cardiac surgery.
abstract: BACKGROUND
  A significantly increased risk of acute kidney injury (AKI) with the prophylactic use of aprotinin has been reported in adults undergoing cardiac surgery, but not in children. Blood product transfusions have also been shown to carry an independent risk of AKI. The present study assessed associations between AKI, aprotinin, and transfusions in neonates and infants undergoing cardiac surgery.
  
  
  METHODS
  All neonates and infants undergoing surgery with cardiopulmonary bypass over a 42 month period, before and after the withdrawal of aprotinin, were included retrospectively. AKI was assessed by the Acute-Kidney-Injury-Network classifications. A propensity score was used to balance treated and untreated groups.
  
  
  RESULTS
  Three hundred and ninety patients received aprotinin and 568 patients did not. Inverse probability of treatment weighting resulted in good balance between groups for baseline and surgical characteristics. Controls underwent surgery with smaller bypass circuits and fewer transfusions. After adjustment for the use of miniaturized circuits and for the year of surgery, no significant association between the incidence of AKI, dialysis, and aprotinin was noted. Red blood cell transfusions were associated with an increased risk of AKI and dialysis: odds ratios (ORs) 1.64 (1.12-2.41) and 2.07 (1.13-3.73), respectively; as were fresh frozen plasma transfusions, ORs 2.28 (1.68-3.09) and 3.11 (1.95-4.97), respectively. Platelet transfusions were associated with an increased risk of dialysis: OR 2.20 (1.21-4.01).
  
  
  CONCLUSIONS
  Blood product transfusions, but not the prophylactic use of aprotinin, are significantly associated with AKI after cardiac surgery in neonates and infants.
authors.affiliation: Department of Anaesthesiolgy and Intensive Care, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France. mirela.bojan@nck.aphp.fr
authors.forename: M
authors.initials: M
authors.lastname: Bojan
authors.forename: S
authors.initials: S
authors.lastname: Vicca
authors.forename: C
authors.initials: C
authors.lastname: Boulat
authors.forename: S
authors.initials: S
authors.lastname: Gioanni
authors.forename: P
authors.initials: P
authors.lastname: Pouard
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000209:etiology* / Q000628:therapy; D007611:Aprotinin / Q000009:adverse effects* / Q000627:therapeutic use; D016913:Blood Component Transfusion / Q000009:adverse effects* / Q000379:methods; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002315:Cardiopulmonary Bypass; D004341:Drug Evaluation / Q000379:methods; D006330:Heart Defects, Congenital / Q000601:surgery*; D006490:Hemostatics / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications; D006435:Renal Dialysis; D012189:Retrospective Studies
chemical_list: D006490:Hemostatics; D007611:Aprotinin