Acute kidney injury (AKI), requiring
renal replacement therapy (RRT). is a serious complication after orthotopic
heart transplantation (HTX). In patients with preexisting impaired renal function, postoperative AKI is unsurprising. However, even in patients with preserved renal function, AKI requiring RRT is frequent. Therefore, this study aimed to identify risk factors associated with postoperative AKI requiring RRT after HTX in this sub-cohort. This retrospective cohort study included patients ≥ 18 years of age with preserved renal function (defined as preoperative glomerular filtration rate ≥ 60 mL/min) who underwent HTX between 2010 and 2021. In total, 107 patients were included in the analysis (mean age 52 ± 12 years, 78.5% male, 45.8% AKI requiring RRT). Based on univariate logistic regression, use of
extracorporeal membrane oxygenation, postoperative
infection,
levosimendan therapy, duration of
norepinephrine (NE)
therapy and maximum daily increase in
tacrolimus plasma levels were chosen to be included into multivariate analysis. Duration of NE
therapy and maximum daily increase in
tacrolimus plasma levels remained as independent significant risk factors (NE: OR 1.01, 95%CI: 1.00-1.02, p = 0.005; increase in
tacrolimus plasma level: OR 1.18, 95%CI: 1.01-1.37, p = 0.036). In conclusion, this study identified long NE
therapy and maximum daily increase in
tacrolimus plasma levels as risk factors for AKI requiring RRT in HTX patients with preserved renal function.