Increasing Creatine Phosphokinase and Myglobine Levels Predict the Development of Acute Renal Failure Immediately after Combined Heart-Lung Transplantation

Abstract

Purpose Combined heart–lung transplantation (HLTx) is a therapeutic option for both adult and pediatric patients since the early 1980s. The leading indications for HLTx are congenital heart disease with Eisenmenger’s syndrome and, historically idiopathic pulmonary arterial hypertension. HLTx is plagued by frequent postoperative acute renal failure (ARF) requiring hemodialysis (up to 80%), by far not always explained by perioperative hemodynamic instability and other well-known risk factors. Here, we hypothesized that high levels of creatine phosphokinase (CPK) or myoglobine would predict acute renal failure after combined heart lung transplantation. Methods and Materials In this study, we present a cohort of 75 patients, who received combined heart and lung transplantation between 2002 and 2012 at Hanover Medical School. In this cohort we defined 2 groups according to the development of ARF requiring hemodialysis after transplant. In both groups CK, CKMB and myoglobin were measured preoperative and at the time of 6h, 12h, POD 1, POD 2, POD 3, POD 4, POD 5, POD 6 and once weekly up to 8 weeks after transplantation. We also assessed at which time after transplant the patients received the first course of hemodialysis. Results Of a total of 75 patients included into this study, 42 developed ARF after transplant und needed hemodialysis. The first course of hemodialysis was necessary on POD 2 (mean). 33 patients showed sufficient renal function. We detected a statistically significant positive correlation between CPK and myglobine levels in blood during the first 48 hours preceeding initiation of hemodialsis and the development of ARF (p Conclusions High CPK and myglobine levels in peripheral blood predict (and might even cause) the development of acute kidney injury immediately after combined heart lung transplantation.