• Friedrich Welz, Felix Schoenrath, Aljona Friedrich, Alexa Wloch, Julia Stein, Felix Hennig, Sascha C Ott, Benjamin O'Brien, Volkmar Falk, Christoph Knosalla, and Isabell Anna Just.
• Deutsches Herzzentrum der Charité. Department of Cardiothoracic and Vascular Surgery, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Speciality Network: Infectious Diseases and Respiratory Medicine, Berlin, Germany. Electronic address: friedrich.welz@dhzc-charite.de.
• J. Cardiothorac. Vasc. Anesth. 2024 May 1; 38 (5): 115011601150-1160.

ObjectiveAcute kidney injury (AKI) requiring renal-replacement therapy (RRT) after heart transplantation (OHT) is common and impairs outcomes. This study aimed to identify independent donor and recipient risk factors associated with RRT after OHT.DesignA retrospective data analysis.SettingData were collected from clinical routines in a maximum-care university hospital.ParticipantsPatients who underwent OHT.InterventionsThe authors retrospectively analyzed data from 264 patients who underwent OHT between 2012 and 2021; 189 patients were eligible and included in the final analysis.Measurements And Main ResultsThe mean age was 48.0 ± 12.3 years, and 71.4% of patients were male. Ninety (47.6%) patients were on long-term mechanical circulatory support (lt-MCS). Posttransplant AKI with RRT occurred in 123 (65.1%) patients. In a multivariate analysis, preoperative body mass index >25 kg/m² (odds ratio [OR] 4.74, p < 0.001), elevated preoperative creatinine levels (OR for each mg/dL increase 3.44, p = 0.004), administration of red blood cell units during transplantation procedure (OR 2.31, p = 0.041) and ischemia time (OR for each hour increase 1.77, p = 0.004) were associated with a higher incidence of RRT. The use of renin-angiotensin-aldosterone system blockers before transplantation was associated with a reduced risk of RRT (OR 0.36, p = 0.013). The risk of mortality was 6.9-fold higher in patients who required RRT (hazard ratio 6.9, 95% CI: 2.1-22.6 p = 0.001). Previous lt-MCS, as well as donor parameters, were not associated with RRT after OHT.ConclusionsThe implementation of guideline-directed medical therapy, weight reduction, minimizing ischemia time (ie, organ perfusion systems, workflow optimization), and comprehensive patient blood management potentially influences renal function and outcomes after OHT.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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