Acute Kidney Injury Increases Mortality After Lung Transplantation

Abstract

Background Acute kidney injury requiring renal replacement therapy (RRT) is associated with increased mortality after cardiac surgery. Studies examining the impact of RRT after lung transplantation (LTx) are limited. We evaluated risk factors and outcomes associated with RRT after LTx. Methods We retrospectively reviewed all LTx recipients in the United Network for Organ Sharing database. Preoperative renal function was stratified by glomerular filtration rate (GFR) as determined by the Modification of Diet in Renal Disease formula (strata: ≥90, 60 to 90, and <60 mL · min−1 · 1.73m−2). Primary outcomes were 30-day, 1-year, and 5-year survival and need for post-LTx RRT. Risk adjusted multivariable Cox proportional hazards regression examined mortality. A multivariable logistic regression model evaluated risk factors for RRT. Results From 2001 to 2011, 12,108 patients underwent LTx. After LTx, 655 patients (5.51%) required RRT. Patients requiring post-LTx RRT had decreased survival at 30 days (96.7% versus 76.0%, p < 0.001), 1 year (85.5% versus 35.8%, p < 0.001), and 5 years (56.4% versus 20.0%, p < 0.001). These differences persisted on multivariable analysis at 30 days (hazard ratio [HR] 7.98 [6.16 to 10.33], p < 0.001), 1 year (HR 7.93 [6.84 to 9.19], p < 0.001), and 5 years (HR 5.39 [4.75 to 6.11], p < 0.001). Preoperative kidney function was an important predictor of post-LTx RRT for a GFR of 60 to 90 (odds ratio 1.42 [1.16 to 1.75], p = 0.001) and a GFR less than 60 (odds ratio 2.68 [2.07 to 3.46], p < 0.001]. High center volume was protective. Conclusions In the largest study to evaluate acute kidney injury after LTx, the incidence of RRT is 5.51%. The need for post-LTx RRT dramatically increases both short- and long-term mortality. Several variables, including preoperative renal function, are predictors of post-LTx RRT and could be used to identify transplant candidates at risk for acute kidney injury.

Perioperative factors associated with 1-year mortality after lung transplantation: a single-center experience in Korea

“…The prevalence of AKI and RRT in our data were higher than in previous reports (41.2% and 16.2%, respectively), the finding in our study that the need for RRT after lung transplantation increased mortality was similar to previous reports (29,30). Several studies have shown the reasons for the high risk of AKI in recipients of lung transplantation; for example, lung injury could induce inflammatory mediators of the renal epithelium, nephrotoxic agents including calcineurin inhibitors could induce direct injury, and efforts to maintain negative balance might cause kidney injury after transplantation.…”

“…AKI after lung transplantation developed in 37%, and the incidence of RRT was 5.51% in some previous studies (29,30). The prevalence of AKI and RRT in our data were higher than in previous reports (41.2% and 16.2%, respectively), the finding in our study that the need for RRT after lung transplantation increased mortality was similar to previous reports (29,30).…”

“…Several studies have shown the reasons for the high risk of AKI in recipients of lung transplantation; for example, lung injury could induce inflammatory mediators of the renal epithelium, nephrotoxic agents including calcineurin inhibitors could induce direct injury, and efforts to maintain negative balance might cause kidney injury after transplantation. Furthermore, some studies suggested that patients with AKI, particularly those requiring RRT, were at an increased risk of mortality (29)(30)(31)(32). However, the reason for increased mortality with the need for RRT is unclear.…”

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“…12 In this study, 8 patients (8%) needed postoperative renal replacement therapy, which is higher than what has been reported earlier. 12 This finding might be due to the small number of patients included. Another explanation could be the different triggers to start renal replacement therapy in different centers.…”

Contemporary analysis of early outcomes after lung transplantation in the elderly using a national registry

“…7,11,[13][14][15] Renal failure continues to be one of the most devastating complications of transplantation, occurring partially as a result of the toxicity profile of immunosuppression therapy. 15 Advancing age is associated with diminished renal function, but, interestingly, we observed no differences in risk of renal failure requiring dialysis between the two groups in either uni-or multivariate analyses. Our results also show that age had no bearing on the risk of rejection at 1 year or on overall hospital LOS.…”