Abstract
Background and aims: The use of aprotinin as antifibrinolytic agent in cardiopulmonary bypass (CPB) has been associated with increased postoperative morbidity and kidney damage in adults. Our goal was to evaluate the relationship between the antifibrinolytic used and development of postoperative renal damage in children.
Methods: Retrospective study including children undergoing CPB surgery during 3 years. Demographic variables, clinical and surgical-related aggressions and antifibrinolytic treatment used were collected. Kidney damage was assesed with pediatric RIFLE criteria (RIFLE-p). Data analysed with chi-square test and multivariate logistic regression.
Results: 403 patients were included. Median age: 7 months (18.1% neonates). Clamping was used in 302 children and circulatory arrest (CA) in 131. The RACHS-1 score was ≥ 4 in 101 patients. Aprotinin was used in 243, and tranexamic acid in 122 children.128 children showed kidney damage. 57 required renal replacement therapy. The group receiving aprotinin showed less kidney damage (27.3% vs 39.5%, p = 0.012). This group had shorter CPB (130 vs 151 min.; p=0.006), less use of CA (23% vs 47%), lower RACHS-1 (23% vs 33% RACHS-1> 4) and included fewer infants (10% vs 31%), p < 0.001. Controlling the effect of age and surgical aggression, no association between use of aprotinin and kidney damage was observed [OR 1.32, IC95% (0.78-2.24), p=0.291].
Conclusions: The antifibrinolytic treatment with aprotinin in extracorporeal circulation has not been associated with increased renal damage in our pediatric group. Further investigations are needed to evaluate the safety profile of aprotinin in children and its influence in renal failure.
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Gil-Esparza, GR., Romero, A., Del Castillo Peral, J. et al. 628 The Impact of Aprotinin in Acute Kidney Injury After Cardiopulmonary Bypass in Pediatric Patients. Pediatr Res 68 (Suppl 1), 321 (2010). https://doi.org/10.1203/00006450-201011001-00628
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DOI: https://doi.org/10.1203/00006450-201011001-00628