The importance of Acute Kidney Injury in patients with Left Ventricular Assist Devices: A Multi-Center study addressing Incidence, Risk Factors and Impact on 1-year Mortality and Renal Function

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R. Muslem, K. Caliskan, S. Akin, K. Sharma, N. Gilotra, A.A. Constantinescu, G. Whitman, R. Tedford, D.A. Hesselink, A. Bogers, S. Russell, O.C. Manintveld

Chair(s): Drs. F.E. van Reekum & dr. M.C. Warlé

Wednesday 8 march 2017

18:42 - 18:54h at Johan de Meesterzaal

Categories: Parallel - Klinisch

Parallel session: Parallelsessie VII - Klinisch 2 - Nazorg na orgaantransplantatie

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Continuous-flow Left ventricle assist devices (CF-LVAD) have become an important tool in the treatment of end-stage heart failure and are increasingly used as bridge-to heart transplantation (BTT). However, CF-LVADs has been recognised as destination therapy when heart transplantation is not possible. The success of this treatment depends on optimal patient selection and patient support after LVAD implantation. Data on the consequences of acute kidney injury (AKI) after CF-LVAD are scarce and inconsistent. In the current study, the incidence and predictors of AKI and its impact on mortality and renal function in the first year after LVAD implantation were evaluated.

A retrospective multicentre cohort study was conducted, including all patients (age ≥18) in who a LVAD was implanted (91% HeartMate II, 9% HVAD) between 2004 and 2015 in the two participating centers. The definition proposed by the Kidney Disease Improving Global Outcome criteria (KDIGO) was used to define AKI. Multivariable analysis was conducted for the association of clinical variables and the onset of AKI and the relation between AKI and renal function at one year.

Overall, 241 patients (mean age 52.4 ± 12.9 years, 76% male, 64% BTT) were included. AKI criteria were met in 169 (70%) LVAD patients, of whom 109 (45%) had AKI stage I, 22 (9%) stage II and 38 (16%) stage III. The need for inotropic support and pre-existent severe kidney failure (eGFR 2, in patients without AKI, stages I, II, and III, respectively (p = 0.038). In multivariable analysis, AKI stages ≥ II were independently associated with a worse renal function at one year (p<0.01).


In conclusion, AKI is highly frequent after CF-LVAD implantation. More severe AKI stages are associated with impaired renal function one year after implantation and with a higher mortality rate in the first year after LVAD implantation. Prevention or mitigation of AKI after CF-LVAD implantation is therefore an important goal of perioperative care.