Retrospective analysis on incidence and risk factors of early onset acute kidney injury after lung transplantation and its association with mortality

Abstract

Objectives: Acute kidney injury (AKI) is a common complication after lung transplantation (LTx) which is closely related to the poor prognosis of patients. We aimed to explore potential risk factors and outcomes associated with early post-operative AKI after LTx. Methods: A retrospective study was conducted in 136 patients who underwent LTx at our institution from 2017 to 2019. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline. Univariate and multivariate analyses were conducted to identify risk factors related to AKI. The primary outcome was the incidence of AKI after LTx. Secondary outcomes were associations between AKI and short-term clinical outcomes and mortality. Results: Of the 136 patients analyzed, 110 developed AKI (80.9%). AKI was associated with higher baseline eGFR (odds ratio (OR) 1.01 (95% confidence interval (CI): 1.00-1.03)) and median tacrolimus (TAC) concentration (OR 1.15 (95% CI: 1.02-1.30)). Patients with AKI suffered longer mechanical ventilation days (p ¼ .015) and ICU stay days (p ¼ .011). AKI stage 2-3 patients had higher risk of 1-year mortality (HR 16.98 (95% CI: 2.25-128.45)) compared with no-AKI and stage 1 patients. Conclusions: Our results suggested early post-operative AKI may be associated with higher baseline eGFR and TAC concentrations. AKI stage 1 may have no influence on survival rate, whereas AKI stage 2-3 may be associated with increased mortality at 1-year.

The impact of cytochrome P450 3A5 genotype on early tacrolimus metabolism and clinical outcomes in lung transplant recipients

“…In LTx, similar results have been reported, but the study population mainly consisted of Caucasians [7][8][9]. Except for a different frequency of CYP3A5*3 allele from Caucasians, males and older recipients seems to account for the majority of Chinese LTx population [10,11]. Till now, studies in this population are limited and usually conducted in small sample sizes, leaving a major void in this area [12,13].…”

“…We attributed this finding to the demographic characteristics of our population. Around half of them were over 60 years old, who might be more vulnerable to AKI [11]. So, clinical pharmacists should pay more attention to their concentrations even when they are within therapeutic range.…”

Medical Complications of Lung Transplantation

“…Post-transplant AKI is a very common complication after LT; it has been reported to occur in 30%–70% of LTRs and is associated with higher mortality and morbidity [ 74 , 81 ]. Multifactorial risk factors contribute to the development of AKI, including advanced age, preoperative severe end-stage lung disease status of the recipient, blood loss and hemodynamic instability, the use of preoperative mechanical ventilation or extracorporeal membrane oxygenation (ECMO), single or double LT type, operation time, and exposure to nephrotoxic agents such as CNIs and antimicrobial drugs in the perioperative period [ 82 , 83 ].…”

Assessing risk factors of acute kidney injury and its influence on adverse outcomes after lung transplantation: methodology is important

“…Assessing risk factors of acute kidney injury and its influence on adverse outcomes after lung transplantation: methodology is important Dear Editor, By a retrospective analysis, Du et al [1] assessed the incidence and risk factors of early-onset acute kidney injury (AKI) during the first week after lung transplantation and its association with postoperative mortality. They showed that a higher baseline estimated glomerular filtration rate (eGFR) was associated with the occurrence of early postoperative AKI.…”