The Prevalence, Risk Factors and Prognosis of Acute Kidney Injury after Lung Transplantation: A Single-center Cohort Study in China

Abstract

Background To evaluate the incidence, risk factors, and prognosis of acute kidney injury (AKI) after lung transplantation (LTx). Methods Records of patients who underwent LTx in a single center were retrospectively reviewed. The prevalence of post-transplant AKI, the use of continuous renal replacement therapy (CRRT), and the risk factors for AKI were investigated. The impact of AKI and CRRT on short-term outcomes and long-term survival was measured. Results 148 patients were included with 67 cases developed post-operative AKI. 31 patients underwent CRRT; the percentage of CRRT was 6.2%, 0%, 10% and 86.2% in no-AKI, and stage 1, 2 and 3 AKI, respectively. Patients with AKI had significantly higher ICU mortality and in-hospital mortality. The 1-year post-LTx survival rate of patients with AKI was 47.8%, significantly lower than those without (74.1%). There was no difference in the 1-year survival rate of those with stage 1 and stage 2 AKI, but patients with stage 3 AKI showed the worst survival. Patients who underwent CRRT had an inferior survival outcome (9.7% vs. 76.1%, P < 0.05). We found that higher APACHE II score (OR 1.082, P = 0.009), and higher intraoperative fluid balance (OR 1.001, P = 0.012) were independent risk factors, and female (OR 2.539) and pulmonary hypertension (OR 2.869) were potential risk factors for post-LTx AKI. A prediction model integration of the above factors showed a good concordance with actual risks and had a C-index of 0.76 (95% CI, 0.66–0.87). Conclusion Severe AKI which needed CRRT had a negative impact on the short-term and long-term outcomes.

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

“…The authors provided the preoperative comorbidities of patients, but not an assessment of overall health status and acute illness conditions before surgery. The available evidence indicates that preoperative higher acute physiologic assessment and chronic health evaluation (APACHE) II scores are the independent risk factors of AKI in patients undergoing lung transplantation [3]. Furthermore, a higher lung allocation score at transplantation, preoperative mean pulmonary artery pressures greater than 35 mm Hg, ICU stay before transplantation and preoperative use of extracorporeal membrane oxygenation or mechanical ventilation have been significantly associated with the occurrence of AKI following lung transplantation [4].…”

“…Thus, it is difficult to determine the extent of influence that anesthesiologists' interventions may have on the occurrence of postoperative AKI. Other than transplant types, operation duration, intraoperative extracorporeal membrane oxygenation support and blood loss provided by the authors, the recent works have shown that intraoperative increased fluid balance, use of vasoactive drugs, hypoxemia, severe arterial hypotension with hemodynamic decompensation are significantly associated with an increased risk of AKI after lung transplantation [3,5]. Indeed, multivariate analysis is useful for the identification of risk factors of adverse perioperative events by adjusting patients' baseline characteristics and controlling selection biases in a retrospective study.…”