Correlation Between Perioperative Blood Transfusion And Acute Kidney Injury After Pediatric Cardiac Surgery With Cardiopulmonary Bypass

BACKGROUND:Children with congenital heart disease (CHD) undergoing open heart surgery with cardiopulmonary bypass (CPB) are more likely to develop acute kidney injury (AKI) in the immediate postoperative period. Recent studies found new evidence which associates blood transfusion with deleterious outcomes. However, transfusion-related AKI in children with CHD was poorly understood. This study aims to investigate the association between blood transfusion and the occurrence of AKI.METHODS:A retrospective single-centre study was performed including487patients from January-September,2010with CHD and had cardiac surgery with CPB. Aristotle Basic Complexity (ABC) propensity score was applied to stratify patients underwent different operations. A≥50%increase in serum creatinine from the preoperative value was defined as AKI according to RIFLE criteria.RESULTS:The cohort included265males (54.4%) and222females (45.6%), with an median age of19month old. AKI occurred in14.0%(68patients) within3days after surgery. No statistic significance in incidence of AKI was found in patients who had more complex procedure(ABC level3+level4vs level1+level2,21.0%vs12.9%, OR=1.78,95%CI0.91-3.50, P=0.088). CPB<60min brought lower incidence of AKI(OR=0.28,95%CI0.16-0.49, P<0.001). More transfusion was associated with remarkably rise in AKI incidence. The heaviest red blood cell transfusion group(>90ml·kg-1) had a OR of16.8(95%CI7.8-36.3,P<0.001) in comparison with the least transfusion group(<60ml·kg-1), while the OR of the heaviest plasma transfusion group(>60ml·kg-1) was6.8(95%CI3.4-13.7, P<0.001) in comparison with the least transfusion group(<40ml·kg-1). Age, perioperative RBC transfusion and perioperative plasma transfusion were independently associated with AKI in multivariate analysis with odds ratio of2.215,1.015and1.020, respectively. In patients group of less complex procedure, CPB duration<60min and>60min, minimum perfusion temperature>28℃, both red blood cell transfusion and plasma transfusion in AKI patients were significantly more than non-AKI patients.CONCLUSIONS:Blood transfusion is related to AKI in children after cardiac surgery with cardiopulmonary bypass. Age and perioperative transfusion, both RBC and plasma, were independently associated with the development of postoperative AKI, suggesting that operation at an elder age and restricted transfusion trigger could reduce the risk of AKI.