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Kidney Week

Abstract: PO0068

AKI After Lung Transplantation: A Retrospective Analysis from a Single Transplantation Center

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Wijk, Johanna, Department of Anesthesia and Intensive Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • Ricksten, Sven-Erik, Department of Anesthesia and Intensive Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • Dellgren, Göran, Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
  • Ederoth, Per, Department of Thorcacic Anesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
  • Grins, Edgars, Department of Thorcacic Anesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
  • Lannemyr, Lukas, Department of Anesthesia and Intensive Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Background

Acute kidney injury (AKI) is a common and serious complication after lung transplantation (Ltx). No data from the Swedish Ltx program have been published, and thus we performed a retrospective analysis of AKI after Ltx at our unit.

Methods

After ethical board approval, all patients ≥18 years who underwent Ltx in Gothenburg, Sweden, between 2012–2016 were assessed. Exclusion criteria were: death within 48 hours, multiple organ transplantations or pre-operative dialysis. AKI was defined according to the KDIGO creatinine criteria and the AKI group was compared to the patients without AKI using Mann-Whitney U-tests or Chi2-tests as appropriate. A multivariate logistic regression model for pre- and intraoperative predictors of AKI was built.

Results

In total, 211 patients were transplanted 2012–2016, and 197 patients were analyzed. Of these, 37% developed AKI within 1 week after Ltx (grade 1; 58%, grade 2; 12%, grade 3; 29%). AKI was associated with increased mortality at 30 days (5.5% vs. 0.8%, p=0.044) and at 1 year (26.0 % vs. 8.9%, p=0.001). In the regression model, higher body mass index, diabetes mellitus, measured GFR < 60 ml/min, tricuspid regurgitation and the use of extra-corporeal circulation during Ltx were independent predictors of postoperative AKI (p<0.001, R2=0.273).

Conclusion

AKI affected more than 1/3 of the patients after Ltx, and was associated with increased time on mechanical ventilation, longer stay in the intensive care unit and increased mortality. The multivariate regression model had a modest predictive value, suggesting that postoperative factors may be important contributors to the development of AKI efter Ltx.

VariableNon-AKI (n=123)AKI (n=73)p-value
Age (years)54±1254±130.980
Female gender69 (56)34 (47)0.218
Diabetes mellitus8 (6)12 (16)0.025
Preoperative s-creatinine (µg/L)70±1978±250.026
Measured GFR (ml/min/1.73 m2)87.7±21.580.0±24.40.025
Body mass index (kg/m2)23.0±4.125.1±5.40.006
Tricuspid regurgitation25 (20)29 (40)0.001
Use of Cardiopulmonary bypass17 (14)28 (38)<0.001
Intraoperative bleeding (ml)515±5501530±36860.024
Postoperative mechanical ventilation (hours)49±159193±360<0.001
Use of RRT within first postoperative week0 (0)14 (19)<0.001
Length of stay in intensive care (days)4.5±6.513.0±15.5<0.001

Data are mean±SD or n (%)

Funding

  • Government Support - Non-U.S.