title: Acute Kidney Injury and Outcome After Heart Transplantation: Large Differences in Performance of Scoring Systems.
abstract: BACKGROUND
  Kidney function is an important aspect for patient outcome after heart transplantation (HTX). Acute kidney injury (AKI) is defined by changes in serum creatinine (SCr) and diuresis with risk/injury/failure/loss/end stage (RIFLE), acute kidney injury network (AKIN), or kidney disease: improving global outcomes (KDIGO) scores.
  
  
  METHODS
  We investigated the effect of perioperative AKI on 1-year mortality after HTX over a period of 10 years at a single-center university hospital. Multivariable Cox proportional-hazards regression analyzed the association between 1-year mortality and potential risk factors. Receiver operating curves for 1-year mortality were calculated to determine sensitivity and specificity of scores.
  
  
  RESULTS
  Sixty of 346 patients (17%) died within the first year. Acute kidney injury was a predictor of mortality only in the high-risk AKI groups of all scores: Hazard ratios (95% confidence interval) for RIFLE F: 7.164 (3.307-15.523); KDIGO/AKIN stage 3: 3.492 (2.006-6.081). Within each score, we identified patient groups, which had no elevated risk for an adverse outcome despite their allocation to the milder forms of AKI. In multivariable regression analysis, primary graft dysfunction was the predominant perioperative risk factor for 1-year mortality.
  
  
  CONCLUSIONS
  In contrast to other patient cohorts, mild forms of perioperative AKI are of subordinate influence on patient outcome in HTX.
authors.affiliation: 1 Division of Cardiothoracic and Vascular Anesthesia and Critical Care Medicine, Medical University of Vienna, Vienna, Austria. 2 Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria. 3 Center for Medical Statistics, Informatics and Intelligent Systems, Section for Clinical Biometrics, Medical University of Vienna, Vienna, Austria. 4 Division of Nephrology and Dialysis, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Arno
authors.initials: A
authors.lastname: Schiferer
authors.forename: Andreas
authors.initials: A
authors.lastname: Zuckermann
authors.forename: Daniela
authors.initials: D
authors.lastname: Dunkler
authors.forename: Farsad
authors.initials: F
authors.lastname: Eskandary
authors.forename: Martin
authors.initials: M
authors.lastname: Bernardi
authors.forename: Michael
authors.initials: M
authors.lastname: Hiesmayr
authors.forename: Andrea
authors.initials: A
authors.lastname: Lassnigg
authors.forename: Doris
authors.initials: D
authors.lastname: Hutschala
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000401:mortality*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index