Is there a renoprotective value to leukodepletion during heart valve surgery? A randomized controlled trial (ROLO)

E Khoshbin*, SALLY SPENCER, Laurence Solomon, Augustine Tang, Stephen Clark, Elizabeth Stokes, Sarah Wordsworth, Lucy Dabner, Julia Edwards, Barnaby Reeves, Chris Rogers

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background: Acute Kidney Injury (AKI) adversely affects outcomes after cardiac surgery. A major mediator of AKI is
the activation of leukocytes through exposure to the cardiopulmonary bypass circuit. We evaluate the use of
leukodepletion filters throughout bypass to protect against post-operative AKI by removing activated leukocytes
during cardiac surgery.
Methods: This is a single-centre, double-blind, randomized controlled trial comparing the use of leukodepletion
versus a standard arterial filter throughout bypass. Elective adult patients undergoing heart valve surgery with or
without concomitant procedures were investigated. The primary clinical outcome measured was the development
of AKI according to the KDIGO criteria. Secondary measures included biomarkers of renal tubular damage (urinary
Retinol Binding Protein and Kidney Injury Molecule-1), glomerular kidney injury (urinary Micro Albumin and serum
Cystatin C) and urinary Neutrophil Gelatinase Associated Lipocalin, as well as the length of hospital stay and quality
of life measures through EQ-5D-5L questionnaires.
Results: The ROLO trial randomized 64 participants with a rate of recruitment higher than anticipated (57% achieved,
40% anticipated). The incidence of AKI was greater in the leukodepletion filter group (44% versus 23%, risk difference
21, 95% CI − 2 to 44%). This clinical finding was supported by biomarker levels especially by a tendency toward
glomerular insult at 48 h, demonstrated by a raised serum Cystatin C (mean difference 0.11, 95% CI 0.00 to 0.23, p =
0.068) in the leukodepleted group. There was however no clear association between the incidence or severity of AKI
and length of hospital stay. On average, health related quality of life returned to pre-operative levels in both groups
within 3 months of surgery.
Conclusions: Leukocyte depletion during cardiopulmonary bypass does not significantly reduce the incidence
of AKI after valvular heart surgery. Other methods to ameliorate renal dysfunction after cardiac surgery need
to be investigated.
Original languageEnglish
Pages (from-to)58
Number of pages10
JournalJournal of Cardiothoracic Surgery
Volume16
DOIs
Publication statusPublished - 28 Mar 2021

Keywords

  • Cardiac surgery
  • Heart valve
  • Cardiopulmonary bypass
  • Acute kidney injury
  • Leuodepletion

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