To analysis the incidence of acute kidney injury (AKI) in orthotopic heart transplantation recipients, and to summarize the experience of prevention and treatment.

The clinical data of 38 recipients undergoing orthotopic heart transplantation from January 2014 to December 2018 admitted to Nanjing First Hospital were retrospectively analyzed. Recipients were divided into AKI group (21 cases) and control group (17 cases) according to the Kidney Disease Improving Global Outcome criteria, and renal function damage staging was determined in those recipients with AKI. The general data and prognosis of the 2 groups were compared. Two independent sample t-test was used for continuous variables and Fisher′s exact probability method was used for categorical variables. P<0.05 was considered statistically significant.

AKI occurred in 21 of the 38 recipients (55.3%) within 7 days after surgery, including 15 cases in AKI stage 1, 4 cases in AKI stage 2, and 2 cases in AKI stage 3. The preoperative pulmonary systolic pressure was (60±18) mmHg (1 mmHg=0.133 kPa), significantly higher than those in the control group [(45±15) mmHg] (t=2.790, P<0.05). Up to June 2019, all the recipients were followed-up 6 to 56 months. The postoperative central venous pressure, postoperative right ventricular diameter and ICU stay in the AKI group were (12.1±4.1) mmHg, (26.1±2.7) mm and (10.0±9.4) days, respectively, greater than those in control group [(9.3±2.8) mmHg, (23.7±2.4) mm and (5.2±1.6) days, respectively], the differences were all statistically significant (t=2.365, 2.829 and 2.038, P all<0.05). After treatment, 12 recipients in AKI stage 1 returned to normal renal function, two recipients developed to chronic renal insufficiency, and one recipient died of multiple organ failure due to severe mediastinal infection. Three recipients in AKI stage 2 returned to normal renal function, one recipient developed to chronic renal insufficiency. Two recipients in AKI stage 3 all responded poorly to diuretics. In the end, one recipient recovered heart function, but remained with chronic renal insufficiency, and another one died of multiple organ failure.

AKI is one of the most common complications among heart transplant recipients, but with active prevention, timely diagnosis, and effective treatment, the renal function of the majority recipients with renal impairment can return to normal.