ACUTE KIDNEY INJURY AFTER LUNG TRANSPLANTATION: PERIOPERATIVE RISK FACTORS AND OUTCOME

Abstract BACKGROUND Acute kidney injury (AKI) is associated with increased short-term and long-term mortality and morbidity after lung transplantation (LT). The primary objective of this study was to analyze the perioperative factors associated with AKI according to KDIGO criteria during hospitalization in an intensive care unit (ICU) after LT. METHODS This was a single-center observational, prospective study. AKI was defined according to KDIGO criteria. Results are expressed as median, interquartile range, absolute numbers and percentages. Statistical analyses were performed using Chi-square test, Fisher’s exact test and Mann-Witney U test (p<0.05 was considered to be significant). Multivariate analysis was performed to identify independent risk factors. RESULTS Between January 2016 and April 2018, 94 patients (pts) underwent LT (70% bilateral LT). AKI occurred during ICU stay in 46 pts (49%). KDIGO 1 AKI was observed in 16 pts (17%), KDIGO 2 in 14 pts (15%), and KDIGO 3 in 16 pts (17%) including 12 pts (75%) who required renal replacement therapy (RRT). AKI occurred before the fifth day after surgery for 38 patients (82% of the AKI patients). On multivariate analysis, independent factors associated with AKI were bilateral LT and mechanical ventilation (MV) > 3 days (OR 4.26 95%CI [1.49; 13.63] p=0.010 and OR 5.56 [1.25; 11.47] p=0.018, respectively). AKI and the need for RRT were significantly associated with ICU mortality, 28-day mortality and one-year mortality. CONCLUSION AKI is common during ICU stay after LT, especially after bilateral LT and is associated with prolonged MV, and increased short-term and long-term mortality.

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The Incidence of Acute Kidney Injury Following Lung Transplantation Performed on Cardiopulmonary Bypass; Risk Factors, Effect on Short and Long-Term Mortality

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2019.01.1068 ◽

2019 ◽

Vol 38 (4) ◽

pp. S419 ◽

Cited By ~ 1

Author(s):

C. Carlheim ◽

A.M. Holm ◽

J.F. Bugge

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cardiopulmonary Bypass ◽

Lung Transplantation ◽

Kidney Injury ◽

Short And Long Term ◽

Long Term Mortality

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

10.21203/rs.3.rs-54054/v1 ◽

2020 ◽

Author(s):

Ling Sang ◽

Sibei Chen ◽

Lingbo Nong ◽

Yonghao Xu ◽

Haichong Zheng ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Survival Rate ◽

Lung Transplantation ◽

Kidney Injury ◽

Apache Ii Score ◽

Single Center ◽

Short Term ◽

Stage 1

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.

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Diagnostics, Risk Factors, Treatment and Outcomes of Acute Kidney Injury in a New Paradigm

Journal of Clinical Medicine ◽

10.3390/jcm9041104 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1104 ◽

Cited By ~ 9

Author(s):

Charat Thongprayoon ◽

Panupong Hansrivijit ◽

Karthik Kovvuru ◽

Swetha R. Kanduri ◽

Aldo Torres-Ortiz ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Kidney Injury ◽

New Paradigm ◽

Short Term ◽

Clinical Environments ◽

Personalized Approach ◽

The Impact ◽

Long Term Mortality

Acute kidney injury (AKI) is a common clinical condition among patients admitted in the hospitals. The condition is associated with both increased short-term and long-term mortality. With the development of a standardized definition for AKI and the acknowledgment of the impact of AKI on patient outcomes, there has been increased recognition of AKI. Two advances from past decades, the usage of computer decision support and the discovery of AKI biomarkers, have the ability to advance the diagnostic method to and further management of AKI. The increasingly widespread use of electronic health records across hospitals has substantially increased the amount of data available to investigators and has shown promise in advancing AKI research. In addition, progress in the finding and validation of different forms of biomarkers of AKI within diversified clinical environments and has provided information and insight on testing, etiology and further prognosis of AKI, leading to future of precision and personalized approach to AKI management. In this this article, we discussed the changing paradigms in AKI: From mechanisms to diagnostics, risk factors, and management of AKI.

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