Abstract: PO0068
AKI After Lung Transplantation: A Retrospective Analysis from a Single Transplantation Center
Session Information
- AKI Clinical, Outcomes, and Trials - 1
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
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.
| Variable | Non-AKI (n=123) | AKI (n=73) | p-value |
| Age (years) | 54±12 | 54±13 | 0.980 |
| Female gender | 69 (56) | 34 (47) | 0.218 |
| Diabetes mellitus | 8 (6) | 12 (16) | 0.025 |
| Preoperative s-creatinine (µg/L) | 70±19 | 78±25 | 0.026 |
| Measured GFR (ml/min/1.73 m2) | 87.7±21.5 | 80.0±24.4 | 0.025 |
| Body mass index (kg/m2) | 23.0±4.1 | 25.1±5.4 | 0.006 |
| Tricuspid regurgitation | 25 (20) | 29 (40) | 0.001 |
| Use of Cardiopulmonary bypass | 17 (14) | 28 (38) | <0.001 |
| Intraoperative bleeding (ml) | 515±550 | 1530±3686 | 0.024 |
| Postoperative mechanical ventilation (hours) | 49±159 | 193±360 | <0.001 |
| Use of RRT within first postoperative week | 0 (0) | 14 (19) | <0.001 |
| Length of stay in intensive care (days) | 4.5±6.5 | 13.0±15.5 | <0.001 |
Data are mean±SD or n (%)
Funding
- Government Support - Non-U.S.