Table 1.
Baseline characteristics and perioperative data according to postoperative AKI stages
| n (%) | No AKI 165 (28) | AKI stage 1 278 (48) | AKI stage 2 66 (11) | AKI stage 3 86 (14) | p value |
|---|---|---|---|---|---|
| Demographics | |||||
| Age, years | 51 (45–56) | 51 (43–57) | 51 (43–57) | 48 (41–55) | 0.23 |
| Male sex | 127 (77) | 208 (75) | 49 (74) | 67 (78) | 0.95 |
| BMI, kg/m2 | 22.6 (20.1–24.5) | 23.2 (21.0–25.2) | 22.9 (20.8–25.8) | 24.2 (22.1–26.8) | < 0.001* |
| Renal function | |||||
| eGFR, ml/min/1.73m2 | 71 (58–88) | 60 (47–79) | 67 (60–79) | 56 (43–70) | < 0.001* |
| eGFR ≥ 90 | 38 (23) | 37 (13) | 11 (17) | 2 (2) | < 0.001* |
| eGFR 60–89 | 79 (48) | 103 (37) | 40 (60) | 33 (38) | |
| eGFR < 60 | 48 (29) | 138 (50) | 15 (23) | 51 (60) | |
| eGFR 45–59 | 31 (19) | 81 (29) | 11 (17) | 27(32) | |
| eGFR < 45 | 17 (10) | 57 (21) | 4 (6) | 24 (28) | |
| Medical history | |||||
| Prior cardiac surgery | 45 (27) | 89 (32) | 15 (23) | 25 (29) | 0.90 |
| Diabetes mellitus | 7 (4) | 19 (7) | 5 (8) | 11 (13) | 0.015* |
| Hypertension | 17 (10) | 29 (10) | 5 (8) | 8 (9) | 0.65 |
| Donor characteristics | |||||
| Age, years | 31 (20–42) | 34 (22–45) | 37 (24–45) | 39 (27–49) | < 0.001* |
| Male sex | 89 (54) | 149 (54) | 28 (42) | 35 (41) | 0.019* |
| Cause of death | 0.61 | ||||
| Trauma | 74 (45) | 117 (42) | 26 (39) | 36 (42) | |
| CVA | 83 (50) | 149 (54) | 38 (58) | 4 (51) | |
| Other | 6 (4) | 11 (4) | 2 (3) | 6 (7) | |
| Unknown | 2 (1) | 1 (0) | 0 (0) | 0 (0) | |
| Time of ischemia donor heart, minutes | 165 (139–196) | 171 (143–206) | 170 (147–195) | 176 (150–210) | 0.09 |
| Urgency status on waiting list | 0.78 | ||||
| Elective | 78 (47) | 166 (60) | 41 (62) | 38 (44) | |
| Urgent | 58 (35) | 73 (26) | 14 (21) | 31 (36) | |
| Unknown | 29 (18) | 39 (14) | 11 (17) | 17 (20) | |
| Preoperative hemodynamic parameters at the time of transplantation listing | |||||
| Days before HTx | 182 (81–331) | 275 (123–545) | 273 (117–505) | 213 (100–534) | 0.15 |
| Heart rate, beats/min | 80 (68–100) | 80 (70–92) | 73 (61–94) | 72 (67–90) | 0.06 |
| Systolic AP, mmHg | 99 (90–106) | 97 (90–105) | 95 (84–105) | 97 (87–107) | 0.27 |
| Diastolic AP, mmHg | 63 (57–70) | 61 (56–69) | 62 (54–69) | 62 (56–72) | 0.91 |
| Mean AP, mmHg | 74 (68–80) | 73 (67–81) | 73 (64–81) | 75 (66–83) | 0.61 |
| Cardiac output, L/min | 3.8 (3.1–4.6) | 4.0 (3.3–4.7) | 3.8 (3.2–4.5) | 3.8 (3.0–4.5) | 0.98 |
| PVR, dync/s/cm2 | 172 (115–230) | 149 (96–224) | 154 (93–245) | 144 (82–226) | 0.44 |
| SVR, dync/s/cm2 | 1442 (1192–1764) | 1286 (1086–1671) | 1398 (1216–1605) | 1333 (1042–1630) | 0.14 |
| RAP, mmHg | 7 (5–12) | 7 (4–11) | 8 (5–13) | 11 (5–17) | 0.021* |
| PA systolic, mmHg | 44 (32–55) | 42 (30–52) | 44 (34–53) | 45 (29–59) | 0.93 |
| PA diastolic, mmHg | 23 (15–30) | 21 (14–29) | 21 (15–30) | 23 (15–29) | 0.78 |
| PA mean, mmHg | 30 (21–39) | 28 (19–36) | 27 (21–37) | 31 (20–38) | 0.84 |
| PCWP, mmHg | 21 (14–29) | 20 (13–26) | 20 (14–27) | 22 (13–29) | 0.81 |
| TPG, mmHg | 8.3 (5.0–11.0) | 7.7 (4.3–10.7) | 7.2 (4.4–10.3) | 7.3 (4.3–10.3) | 0.25 |
| DPG, mmHg | 1.0 (–2.0–4.0) | 1.0 (–2.0–4.0) | 0.0 (–2.0–3.0) | 0.0 (–2.0–4.0) | 0.93 |
| PAPi | 2.83 (1.89–5.81) | 3.17 (1.61–5.67) | 2.54 (1.82–5.60) | 2.31 (1.01–4.57) | 0.012* |
| RAP-to-PCWP ratio | 0.37 (0.24–0.57) | 0.36 (0.23–0.52) | 0.40 (0.25–0.53) | 0.47 (0.29–0.74) | 0.009* |
| Preoperative hemodynamic support | |||||
| Inotropes | 41 (25) | 59 (21) | 15 (23) | 29 (34) | 0.16 |
| IABP/ECMO | 16 (10) | 20 (7) | 5 (8) | 10 (12) | 0.68 |
| LVAD | 14 (8) | 15 (5) | 1 (1) | 5 (6) | |
| Postoperative complications | |||||
| Right ventricle failure | 11 (7) | 14 (5) | 8 (12) | 24(28) | < 0.001* |
| Re-thoracotomy | 12 (7) | 18 (6) | 9 (14) | 12 (14) | 0.06 |
| Primary graft failure | 3 (2) | 4 (1) | 4 (6) | 2 (2) | 0.14 |
| Othera | 7 (4) | 14 (5) | 1 (1) | 7 (8) | |
| Immunosuppressive therapy | |||||
| Induction therapy (yes) | 148 (90) | 222 (80) | 47 (71) | 58 (67) | < 0.001* |
| ATG use | 89 (54) | 151 (54) | 29 (44) | 46 (53) | 0.58 |
| Anti-CD3 | 45 (27) | 41 (15) | 5 (7) | 5 (6) | < 0.001* |
| Anti-IL2 | 14 (9) | 30 (11) | 13 (20) | 7 (8) | 0.49 |
| Postoperative delay CNIb, days | 3 (2–5) | 3 (1–4) | 2 (0–3) | 2 (0–5) | 0.35 |
| Hospital stay | |||||
| Days in ICU | 3 (2–4) | 3 (2–4) | 4 (3–6) | 8 (4–14) | < 0.001* |
| Days in hospital | 20 (16–29) | 24 (17–33) | 24 (17–32) | 37 (23–58) | < 0.001* |
| In-hospital mortality | 4 (2) | 15 (5) | 9 (14) | 8 (9) | 0.003* |
Due to uniformity, all continuous data are presented as median and IQR; all categorical data as number and percentage
eGFR estimated glomerular filtration rate, HTx heart transplantation, AP arterial pressure, PVR pulmonary vascular resistance, SVR systemic vascular resistance, RAP right atrial pressure, PA pulmonary artery, PCWP pulmonary capillary wedge pressure, TPG trans-pulmonary gradient, DPG diastolic pulmonary gradient, PAPi pulmonary artery pulsatility index, IABP intra-aortic balloon pump, LVAD left ventricular assist device, ECMO extracorporeal membrane oxygenator, ICU intensive care unit, ATG anti-thymocyte globulins
*p value for a linear trend < 0.05 is statistically significant
aOther includes: perioperative bleeding, cardiac arrest, dosing of inotropes, pacemaker malfunction, acute rejection, and instability of unknown cause
bPostoperative delay after heart transplantation before starting CNI