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Hod T, Oberman B, Scott N, Levy L, Shlomai G, Beckerman P, Cohen-Hagai K, Mor E, Grossman E, Zimlichman E, Shashar M. Predictors and Adverse Outcomes of Acute Kidney Injury in Hospitalized Renal Transplant Recipients. Transpl Int 2023; 36:11141. [PMID: 36968791 PMCID: PMC10033630 DOI: 10.3389/ti.2023.11141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
Data about in-hospital AKI in RTRs is lacking. We conducted a retrospective study of 292 RTRs, with 807 hospital admissions, to reveal predictors and outcomes of AKI during admission. In-hospital AKI developed in 149 patients (51%). AKI in a previous admission was associated with a more than twofold increased risk of AKI in subsequent admissions (OR 2.13, p < 0.001). Other major significant predictors for in-hospital AKI included an infection as the major admission diagnosis (OR 2.93, p = 0.015), a medical history of hypertension (OR 1.91, p = 0.027), minimum systolic blood pressure (OR 0.98, p = 0.002), maximum tacrolimus trough level (OR 1.08, p = 0.005), hemoglobin level (OR 0.9, p = 0.016) and albumin level (OR 0.51, p = 0.025) during admission. Compared to admissions with no AKI, admissions with AKI were associated with longer length of stay (median time of 3.83 vs. 7.01 days, p < 0.001). In-hospital AKI was associated with higher rates of mortality during admission, almost doubled odds for rehospitalization within 90 days from discharge and increased the risk of overall mortality in multivariable mixed effect models. In-hospital AKI is common and is associated with poor short- and long-term outcomes. Strategies to prevent AKI during admission in RTRs should be implemented to reduce re-admission rates and improve patient survival.
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Affiliation(s)
- Tammy Hod
- Renal Transplant Center, Sheba Medical Center, Ramat Gan, Israel
- Nephrology Department, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- *Correspondence: Tammy Hod,
| | - Bernice Oberman
- Bio-Statistical and Bio-Mathematical Unit, The Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Noa Scott
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Liran Levy
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Gadi Shlomai
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Internal Medicine D and Hypertension Unit, The Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat Gan, Israel
| | - Pazit Beckerman
- Nephrology Department, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Keren Cohen-Hagai
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Eytan Mor
- Renal Transplant Center, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ehud Grossman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center, Ramat Gan, Israel
| | - Eyal Zimlichman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center, Ramat Gan, Israel
| | - Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel
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2
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Beurton A, Fajardie A, Rubin S, Belnou P, Aguerreche C, Pernot M, Mion S, Imbault J, Ouattara A. Impact of previous REnal TRansplantation on the mid-term renal Outcome after CARdiac surgery: the RETROCAR trial. Nephrol Dial Transplant 2023; 38:463-471. [PMID: 36099910 DOI: 10.1093/ndt/gfac269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is one of the most common complications after cardiac surgery with cardiopulmonary bypass (CPB). Renal transplant recipients (RTRs) have a higher risk of cardiac surgery-associated AKI (CSA-AKI). A relationship has been strongly suggested between AKI and poor long-term graft survival. The main objective was to evaluate the impact of on-pump cardiac surgery on the 1-year renal allograft survival rate. METHODS The study population consisted of 37 RTRs and 56 non-RTRs who underwent cardiac surgery between 1 January 2010 and 31 December 2019. They were matched according to age, sex, preoperative glomerular function, diabetes and type of surgery. The primary composite outcome was renal survival, defined as patient survival without the requirement for permanent dialysis or new kidney transplantation at 1 year after surgery. RESULTS The renal survival rate was significantly lower in the RTR group than in the non-RTR group [81% versus 96%; odds ratio 0.16 (95% confidence interval 0.03-0.82), P = .03]. The proportion of patients who returned to permanent dialysis was higher in the RTR group than in the non-RTR group (12% versus 0%; P = .02). The proportion of patients with severe AKI was also higher in the RTR group. At 1 year after surgery, serum creatinine level, glomerular filtration rate and all-cause mortality rates were comparable between both groups. CONCLUSION Patients with a functional renal allograft have a low 1-year renal allograft survival rate after cardiac surgery with CPB. In addition, these patients have significant risks of AKI and acute kidney disease after open-heart surgery.
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Affiliation(s)
- Antoine Beurton
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medical Surgical Centre, Bordeaux, France.,University of Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Antoine Fajardie
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medical Surgical Centre, Bordeaux, France
| | - Sebastien Rubin
- University of Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France.,CHU Bordeaux, Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin Hospital, Bordeaux, France
| | - Pierre Belnou
- CHU Bordeaux, Department of Public Health, Service of Medical Information, Informatics and Medical Archives, Bordeaux, France
| | - Clement Aguerreche
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medical Surgical Centre, Bordeaux, France
| | - Mathieu Pernot
- University of Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France.,CHU Bordeaux, Department of Cardiovascular Surgery, Haut-Lévêque Hospital, Bordeaux, France
| | - Stefano Mion
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medical Surgical Centre, Bordeaux, France.,University of Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Julien Imbault
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medical Surgical Centre, Bordeaux, France.,University of Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Alexandre Ouattara
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medical Surgical Centre, Bordeaux, France.,University of Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France
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3
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Büttner S, Zöller C, Patyna S, Gradascevic A, Weiler H, Rosenberg M, Walther T, Zeiher AM, Geiger H, Vasa-Nicotera M, Hauser IA, Fichtlscherer S. Risk of graft loss in kidney transplant recipients after aortic valve replacement. BIOMOLECULES AND BIOMEDICINE 2023; 23:145-152. [PMID: 35880351 PMCID: PMC9901896 DOI: 10.17305/bjbms.2022.7720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/11/2022] [Indexed: 02/08/2023]
Abstract
Surgical aortic valve replacement (SAVR) in kidney transplant recipients (KTR) is associated with high morbidity and mortality, and an increased risk of postoperative graft failure potentially leading to graft loss. Transcatheter aortic valve implantation (TAVI) emerged as an alternative in high-risk patients. However, data on TAVI in kidney transplant recipients are limited. We performed a retrospective analysis of 40 KTR in which aortic valve replacement was performed at our center between 2005 and 2015. The outcomes and follow-up of TAVI (n=20; 2010-2015) and SAVR (n=20; 2005-2015) were analyzed with respect to patient and graft survival. Baseline characteristics in both groups were comparable. Hospital stay after TAVI was significantly shorter compared to SAVR (19 [11.5-21.75] days vs. 33 [21-62] days, p=0.001). Acute graft failure occurred more frequently after SAVR (45% vs. 89.5%; p=0.006). Thirty-day mortality was 10% in both groups. However, in-hospital mortality reached 25% in the SAVR group (TAVI 10%), indicating a more complicated course after surgery. Moreover, during a median follow-up time of 1928 days in TAVI patients and 2717 days in patients after SAVR, graft loss occurred only in the surgically treated group (n=7). While one-year survival after TAVR was 90% compared to 69% after SAVR, long-term follow-up showed comparable results (at 5 years: TAVI 58% vs. 52% SAVR; log-rank-test: p=0.86). In KTR, TAVI can be performed with good mid- to long-term results. Compared to SAVR, renal outcomes seem to be improved after TAVI, suggesting better graft survival.
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Affiliation(s)
- Stefan Büttner
- Medical Clinic III – Department of Nephrology, University Hospital Frankfurt, Frankfurt am Main, Germany,Medical Clinic I – Cardiology, Pneumology, Nephrology and Intensive Care Medicine, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany,Correspondence to Stefan Büttner:
| | - Carolin Zöller
- Medical Clinic III – Department of Nephrology, University Hospital Frankfurt, Frankfurt am Main, Germany,Medical Clinic II – Nephrology, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany,Medical Clinic III – Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sammy Patyna
- Medical Clinic III – Department of Nephrology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Anisa Gradascevic
- Medical Clinic I – Cardiology, Pneumology, Nephrology and Intensive Care Medicine, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Helge Weiler
- Medical Clinic I – Cardiology, Pneumology, Nephrology and Intensive Care Medicine, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Mark Rosenberg
- Medical Clinic I – Cardiology, Pneumology, Nephrology and Intensive Care Medicine, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Thomas Walther
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andreas M Zeiher
- Medical Clinic III – Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Helmut Geiger
- Medical Clinic III – Department of Nephrology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Mariuca Vasa-Nicotera
- Medical Clinic III – Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ingeborg A Hauser
- Medical Clinic III – Department of Nephrology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stephan Fichtlscherer
- Medical Clinic III – Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main, Germany
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Lai D, Wang L, Li JR, Chen C, Zhao WL, Yuan Q, Ma X, Zhang X. Transcriptional progressive patterns from mild to severe renal ischemia/reperfusion-induced kidney injury in mice. Front Genet 2022; 13:874189. [PMID: 35938014 PMCID: PMC9355309 DOI: 10.3389/fgene.2022.874189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/01/2022] [Indexed: 12/02/2022] Open
Abstract
The renal ischemia/reperfusion (I/R)-induced acute kidney injury incidence after nephron-sparing surgery for localized renal tumors is 20%, but the biological determinant process of postoperative acute kidney injury remains unclear. Using Gene Expression Omnibus database (GSE192883) and several bioinformatics analyses (discrete time points analysis, gene set enrichment analysis, dynamic network biomarker analysis, etc), combined with the establishment of the I/R model for verification, we identified three progressive patterns involving five core pathways confirmed using gene set enrichment analysis and six key genes (S100a10, Pcna, Abat, Kmo, Acadm, and Adhfe1) verified using quantitative polymerase chain reaction The dynamic network biomarker (DNB) subnetwork composite index value is the highest in the 22-min ischemia group, suggesting the transcriptome expression level fluctuated sharply in this group, which means 22-min ischemia is an critical warning point. This study illustrates the core molecular progressive patterns from mild to severe I/R kidney injury, laying the foundation for precautionary biomarkers and molecular intervention targets for exploration. In addition, the safe renal artery blocking time of nephron-sparing surgery that we currently accept may not be safe anymore.
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Affiliation(s)
- Dong Lai
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lei Wang
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jia-Rui Li
- Biomedical Innovation Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Chen Chen
- Biomedical Innovation Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Wen-Lei Zhao
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qing Yuan
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xin Ma
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xu Zhang
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
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Chen JJ, Kuo G, Lee TH, Yang HY, Wu HH, Tu KH, Tian YC. Incidence of Mortality, Acute Kidney Injury and Graft Loss in Adult Kidney Transplant Recipients with Coronavirus Disease 2019: Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10215162. [PMID: 34768682 PMCID: PMC8584628 DOI: 10.3390/jcm10215162] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 02/07/2023] Open
Abstract
The adverse impact of Coronavirus disease 2019 (COVID-19) on kidney function has been reported since the global pandemic. The burden of COVID-19 on kidney transplant recipients, however, has not been systematically analyzed. A systematic review and meta-analysis with a random-effect model was conducted to explore the rate of mortality, intensive care unit admission, invasive mechanical ventilation, acute kidney injury, kidney replacement therapy and graft loss in the adult kidney transplant population with COVID-19. Sensitivity analysis, subgroup analysis and meta-regression were also performed. Results: we demonstrated a pooled mortality rate of 21% (95% CI: 19−23%), an intensive care unit admission rate of 26% (95% CI: 22–31%), an invasive ventilation rate among those who required intensive care unit care of 72% (95% CI: 62–81%), an acute kidney injury rate of 44% (95% CI: 39–49%), a kidney replacement therapy rate of 12% (95% CI: 9–15%), and a graft loss rate of 8% (95% CI: 5–15%) in kidney transplant recipients with COVID-19. The meta-regression indicated that advancing age is associated with higher mortality; every increase in age by 10 years was associated with an increased mortality rate of 3.7%. Regional differences in outcome were also detected. Further studies focused on treatments and risk factor identification are needed.
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Affiliation(s)
- Jia-Jin Chen
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan City 33305, Taiwan; (J.-J.C.); (G.K.); (T.H.L.); (H.-Y.Y.); (H.H.W.); (K.-H.T.)
| | - George Kuo
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan City 33305, Taiwan; (J.-J.C.); (G.K.); (T.H.L.); (H.-Y.Y.); (H.H.W.); (K.-H.T.)
| | - Tao Han Lee
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan City 33305, Taiwan; (J.-J.C.); (G.K.); (T.H.L.); (H.-Y.Y.); (H.H.W.); (K.-H.T.)
| | - Huang-Yu Yang
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan City 33305, Taiwan; (J.-J.C.); (G.K.); (T.H.L.); (H.-Y.Y.); (H.H.W.); (K.-H.T.)
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
| | - Hsin Hsu Wu
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan City 33305, Taiwan; (J.-J.C.); (G.K.); (T.H.L.); (H.-Y.Y.); (H.H.W.); (K.-H.T.)
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
| | - Kun-Hua Tu
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan City 33305, Taiwan; (J.-J.C.); (G.K.); (T.H.L.); (H.-Y.Y.); (H.H.W.); (K.-H.T.)
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
| | - Ya-Chung Tian
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan City 33305, Taiwan; (J.-J.C.); (G.K.); (T.H.L.); (H.-Y.Y.); (H.H.W.); (K.-H.T.)
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
- Correspondence:
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6
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Bansal A, Agrawal A, Jain V, Harb SC, Miyasaka R, Yun J, Reed G, Krishnaswamy A, Kapadia SR. Short Term Outcomes of Transcatheter Mitral Valve Repair in Renal Transplant Recipients. Am J Cardiol 2021; 150:124-126. [PMID: 33775633 DOI: 10.1016/j.amjcard.2021.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Agam Bansal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Vardhmaan Jain
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rhonda Miyasaka
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - James Yun
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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