Introduction: The definition of AKI has undergone a significant evolution, moving from the RIFLE and AKIN criteria to the more comprehensive KDIGO classification. Acute kidney Injury (AKI) is defined as a sudden decrease in glomerular filtration rate (GFR) with a rise in blood urea nitrogen (BUN) and creatinine.4 Cardiac transplantation carries a substantial risk of acute kidney injury (AKI), with reported incidences varying widely from 14% to 76%.This significant variability underscores the need for further research to identify specific patient factors and optimize preventive strategies. This study on acute kidney injury (AKI) in heart transplant recipients is novel as we perform a high number of heart transplants in Narayana Hrudyalaya and due to an overall lack of data on this topic in the Indian subcontinent.
Methods: Aim -To analyse the clinical spectrum of acute kidney injury after heart transplant.
Study Design – Retrospective + prospective observational study
Sample size – 45
Study Duration –2008 - 2024
Inclusion Criteria -Adult patients of 18 years age or older who have undergone cardiac transplantation.
Exclusion Criteria- Patients less than 18 years of age and who have undergone multiorgan transplant
Results: Among 45 subjects, 41 were male and 4 were female. The primary cardiac disease was ischaemic in 40%. 22% of recipients had diabetes mellitus and 13.3% had chronic kidney disease at the baseline. 34/45 – 75.6% developed PO AKI. 37.8 (17/45) required RRT. 40% developed stage 3 AKI, 31.1% developed stage 1 and 4.4% developed stage 2 AKI. 73 % received basiliximab, 20% received ATG and 6.7% received nil induction.Significant correlation was present between use of intraop ECMO and AKI requiring RRT . ( p -0.004). Significant correlation was found between reoperation for bleeding and AKI requiring RRT ( p – 0.001). No significant correlation was found between use of intraopIABP  and sepsis with PO AKI and AKI requiring RRT. Significant correlation was found between primary graft dysfunction and AKI requiring RRT. ( p – 0.002).Cardiopulmonary bypass time, cross clamp time and donor heart ischaemia time did not show significant correlation with PO AKI and AKI requiring RRT. CNI trough levels also did not show significant correlation with PO AKI. Stages of AKI and AKI requiring RRT showed significant correlation to 30 day mortality ( p -0.006, p-0.0001) as well as with 1 year mortality. ( p – 0.009, p-0.0001).
Conclusion: This study underscores the significant burden of AKI following heart transplantation. Our findings highlight the importance of identifying high-risk patients and implementing preventive strategies to minimize the development and severity of AKI.  Future research should focus on developing risk stratification models and investigating potential therapeutic interventions to improve long-term outcomes for heart transplant recipients.