Abstract: FR-PO124

AKI after Cytoreductive Surgery and Intraoperative Cisplatin Exposure for Malignant Pleural Mesothelioma

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Hod, Tamar, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Freedberg, Katherine J., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Chen, Margaret E., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Bonventre, Joseph V., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Waikar, Sushrut S., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background

Cytoreductive surgery with or without intraoperative administration of intrathoracic cisplatin is a treatment for certain cases of malignant pleural mesothelioma. The combinations of surgery-induced inflammation, ischemia, and nephrotoxin administration increase the risk of acute kidney injury (AKI), but has not been thoroughly investigated in this unique patient population exposed to multiple kidney insults.

Methods

We assembled a retrospective cohort of patients undergoing cytoreductive surgery with or without intraoperative cisplatin for malignant pleural mesothelioma at Brigham and Women’s Hospital between 2006-2015. We defined AKI according to the KDIGO criteria. Pre-operative characteristics, intra-operative blood loss, and post-operative outcomes of mortality and length of stay were compared in those who did versus did not develop post-operative AKI.

Results

Post-operative AKI occurred in over three quarters of the 504 patients studied (379 of 504, 75.2%); 261 (51.8%) had stage 1 AKI; 85 (16.9%) had stage 2 AKI, and 33 (6.5%) had stage 3 AKI. 16 patients required dialysis. 391 patients (77.6%) received intraoperative cisplatin. The following variables were found to be associated with an increased odds for postoperative AKI: baseline estimated glomerular filtration rate (odds ratio (OR) 0.97; 95% CI 0.96-0.99), male sex (OR 3.44; 95% CI 1.95-6.09), estimated blood loss during surgery (OR 1.47; 95% CI 1.07-2.02) and exposure to intraoperative cisplatin (OR 3.51; 95% CI 1.47-8.39). Higher stages of AKI were associated with longer length of stay (14.8 vs. 16.3 vs. 18.4 vs 30.2 days) and with increased risk of death at 1 year (30.4% vs. 26.4% vs. 41.2% vs 60.6%) for no AKI, stage 1 AKI, stage 2 AKI, and stage 3 AKI, respectively; P < 0.001).

Conclusion

Cytoreductive surgery with intraoperative cisplatin for the treatment of malignant pleural mesothelioma is associated with a substantially higher risk of post-operative AKI than other surgical procedures such as cardiac surgery. The high rate of AKI in this unique patient population makes it a suitable setting for investigation into ischemic and nephrotoxic AKI in humans.