SP240
EARLY POST OPERATIVE ACUTE KIDNEY INJURY AFTER CARDIAC TRANSPLANTATION INCIDENCE AND PREDICTIVE FACTORS Free

INTRODUCTION AND AIMS: In a patient with end-stage heart failure, heart transplantation is now the only available therapeutic choice that has been shown to have a enthusiastic influence on survival.Transplantation is a procedure with a high morbidity and mortality rate, which is probably higher than that of other cardiac surgeries. Acute kidney dysfunction is common complication after heart transplantation and the risk factors for the phenomenon in this population are various, including drugs and different settings of surgery. The purpose of the present study was to determine the incidence and predictors of renal dysfunction among 126 patients in early post-operative heart transplantation.

METHODS: The study was conducted at the department of cardio-thoracic intensive care unit of an affiliated teaching hospital. At this institution, nearly 126 patients had cardiac transplantation surgery during last four years . Information from these patients is collected on a daily basis using standardized case report forms; all clinical perioperative data (including demographics, laboratory tests, nature of surgery, blood product transfusions, re-exploration, postoperative complications, and lengths of stay in the ICU and in the hospital) are collected. This retrospective single-center cohort study aimed to determine predictors and clinical implications of early post operative acute kidney injury ( AKI ) , defined according to Risk, Injury, Failure, Loss and End-stage kidney disease (RIFLE) criteria and need for continuous renal replacement therapy after heart transplantation.

RESULTS: Incidence of AKI was 58% and need for renal replacement therapy 10%.RIFLE scoring was: Normal 41%, Risk 48.5%, Injury 7.9% and Failure 2.4%..Univariate predictors of AKI were: Age(yr),Duration of Anesthesia(hr) ,Cold Ischemia Time(min),Voluven(Startch) Dose(ml),Pre-transplant BUN(mg/dl),Pre-transplant Cr(mg/dl),Pre-transplant Albumin(gr/dl) 3^rd day AST, 3^rd day ALT, 3^rd day Hb and Urine Output in first 6 hour Post OR(ml)) (<200ml/hr). Independent predictors of AKI were several features of the surgical procedure (graft ischemic time, previous cardiac operation, and transfusion of >4 blood units).

CONCLUSIONS: To the best of our knowledge, occurrence of AKI, even in milder degree, is prognostically important. Several surgical factors have been disclosed as independent predictors of AKI. Some of them may be used for preoperative risk stratification and may be amenable to modification. In this respect, the findings of this study, together with those forwarded by the literature, argue for a redefinition of current allocation protocols and a judicious evaluation of distant heart grafts. Several variables, such as donor age and stability, inotropic use, and left- ventricular morphology and function should be factored besides the length of ischemic time in the decision of whether to accept or reject a given donor heart. Donor/ recipient matching should similarly take into account the global burden of distant/marginal heart procurement in the setting of more complex surgical procedures.