The impact of postoperative acute kidney injury on survival after surgery for type A aortic dissection repair: Results from over 6000 patients

IntroductionAcute kidney injury (AKI) is commonly observed after Type A aortic dissection (TAAD) repair and is associated with increased morbidity and mortality. The long-term impact of postoperative AKI, including the influence of severity and operative factors, remains incompletely defined.MethodsWe conducted a systematic review and meta-analysis of studies reporting long-term survival after surgical TAAD repair stratified by postoperative AKI status, published through February 2025. Kaplan-Meier curves were digitized to reconstruct individual patient data.ResultsNine studies with 6,608 patients were analyzed. Postoperative AKI occurred in 35.6% (95% CI 26.4-45.9%) and was associated with three-fold higher long-term mortality (HR 3.00, 95% CI 2.59-3.49, p < 0.001). Survival for AKI versus non-AKI patients was 75% (95% CI 73-77) versus 93% (95% CI 92-94) at 1 year and 52% (95% CI 47-58) versus 68% (95% CI 59-77) at 10 years, with a 2-years reduction in expected survival (95% CI -2.35 to -1.64, p < 0.001). Mortality was time-dependent, with early 3-months risk markedly elevated (HR 4.72, 95% CI 3.82-5.83) and sustained beyond 3 months (HR 1.74, 95% CI 1.41-2.15). Risk increased with AKI severity: stage 1 HR 1.79 (95% CI 1.30-2.48), stage 2 HR 2.88 (95% CI 2.02-4.10), stage 3 HR 5.06 (95% CI 3.75-6.81). Multiple sensitivity analyses confirm robustness.ConclusionPostoperative AKI affects one-third of TAAD patients and triples long-term mortality, especially early after surgery. These findings highlight the need for renal-protective strategies, careful operative planning, and structured follow-up to improve outcomes.