Acute kidney injury influences mortality in lung transplantation

Abstract

Objective: To evaluate the association between acute kidney injury (AKI) and long-term survival in lung transplant patients. Methods: Clinical data of 88 patients who underwent lung transplantation (LTx) were retrospectively analyzed at our institution from September 2002 to December 2011. Postoperative AKI was defined and divided into three groups based on creatinine criteria from the Acute Kidney Injury Net (AKIN) classification. A multivariable logistic regression model evaluated risk factors for AKI. Primary outcome was 5-year mortality. Risk adjusted multivariable COX proportional hazards regression examined the association of AKI with mortality. Results: A total of 47 (53.40%) patients developed AKI (27 with AKIN1, 20 with AKIN2-3) in the first week after LTx. Multivariate analysis showed pre-LT (pre-lung transplant) hypertension (OR 1.37 [0.06–2.68], p = 0.041) and mechanical ventilation (OR 0.05 [0.01–0.09], p = 0.022) were risk factors for postoperative AKI. Five-year survival rates in the non-AKI, AKIN1, and AKIN2-3 groups were 48.8%, 37.0%, 30.0%, respectively (p = 0.041). Adjusted for age, sex, type and cause of LT, hypertension and diabetes, the hazard ratio for death was 1.481 ([1.040–2.107]) for AKI. Conclusions: The occurrence of AKI after LTx is common. Severe AKI would increase long-term mortality risk. Several variables, including pre-LT hypertension and mechanical ventilation, are associated with AKI after LTx.

• Acute kidney injury
• AKIN classification
• factors
• lung transplantation
• mortality

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Expression of concern

Acknowledgements

Partial results will be presented at the World Congress of Nephrology, Hong Kong, China, 2013.