Acute kidney injury influences mortality in lung transplantation

Figures & data

Table 1. Characteristics of recipients of lung transplant by acute kidney injury status^a.

	Group 1	Group 2	Group 3
Variable	No-AKI	AKIN 1	AKIN 2–3	p Value
Total	41 (46.6%)	27 (30.7%)	20 (22.7%)
Gender				0.058
Male	35 (85.4%)	19 (70.4%)	13 (65.0%)
Female	6 (14.6%)	8 (29.6%)	7 (35.0%)
Age, years	51.88 ± 15.28	53.11 ± 11.71	53.90 ± 13.86	0.619
Primary diagnosis of LT				0.955
IPF	21 (51.2%)	16 (59.3%)	9 (45.0%)
COPD	9 (22.0%)	5 (18.5%)	5 (25.0%)
Bronchiectasis	4 (9.8%)	2 (7.4%)	1 (5.0%)
PAH	1 (2.4%)	0 (0.0%)	1 (5.0%)
Other^b (%)	6 (14.6%)	4 (14.8%)	4 (20.0%)
Pre-LT comorbidities
Diabetes mellitus	6 (14.6%)	4 (14.8%)	4 (19.0%)	0.850
Hypertension	4 (9.76%)	7 (25.9%)	8 (38.1%)	0.022
BP before surgery	106.21 ± 25.13	107.39 ± 31.54	106.35 ± 30.96	0.893
Baseline SCr, µmol/L	63.13 ± 16.67	62.40 ± 17.70	57.74 ± 16.75	0.569
SCr when AKI diagnosed, µmol/L	68.11 ± 24.07	103.96 ± 33.89	161.92 ± 67.26	<0.001
Type of LT				0.947
Double	18 (43.9%)	12 (44.4%)	8 (40.0%)
Single	23 (56.1%)	15 (55.6%)	12 (60.0%)
Operation duration, min	397.34 ± 116.75	385.67 ± 96.84	361.05 ± 104.99	0.474
Lung ischemia time, min	350 ± 340	365 ± 355	347 ± 350	0.564
MBP^c, mmHg	94 ± 25	57 ± 30	45 ± 30	<0.001
Blood transfusions, ml	1200 ± 1100	1680 ± 1240	1800 ± 1120	0.088
Estimated blood loss, ml	1400 ± 1175	1720 ± 1320	2000 ± 1250	0.054
Duration of MV, days	10.10 ± 9.17	17.48 ± 14.11	23.55 ± 14.88	<0.001
ECMO support	28 (68.3%)	13 (48.1%)	4 (20.0%)	0.002
Use CPB	2 (4.9%)	2 (7.4%)	1 (5.0%)	0.739
Medications
ACEI/ARB	9 (22.5%)	5 (20.8%)	3 (15.8%)	0.836
Inotropic support	9 (22.0%)	10 (37.0%)	8 (40.0%)	0.108
Aprotinin	16 (39.0%)	12 (44.4%)	12 (60.0%)	0.151
Calcineurin inhibitors				0.717
Tacrolimus	23 (56.1%)	14 (51.9%)	9 (45.0%)
Cyclosporine	18 (43.9%)	13 (48.1%)	11 (55.0%)
Sepsis	2 (4.9%)	4 (14.8%)	5 (25.0%)	0.027

Notes: Categoric data are presented as number (%), continuous data as mean with standard deviation or median with inter-quartile range depending on variable distribution.

LT, lung transplant; IPF, idiopathic pulmonary fibrosis; COPD, chronic obstructive disease; PAH, pulmonary arterial hypertension; BP, blood pressure; SCr, serum creatinine; AKI, acute kidney injury; MBP, mean blood pressure; MV, mechanical ventilation; ECMO, extracorporeal membrane oxygenation; CPB, cardiopulmonary bypass; ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blocker.

^aAKI was defined as AKIN criteria.

^bOther consisted of obliterative bronchiolitis, pulmonary tuberculosis, pulmonary lymphangiomyo-matosis, metastatic pulmonary carcinoma, pneumonoconiosis, organized pneumonia after ARDS.

^cPerioperative mean blood pressure was measured at ten minutes after lung artery blockage.

Figure 1. Median hospital stay and ICU stay by acute kidney injury status.

Figure 2. eGFR of those patients who had survived over 5 years.

Figure 3. Kaplan–Meier estimates of 5-year survival stratified by acute kidney injury network (AKN) classification. AKIN 1 versus no AKI, long-rank p = 0.231; AKIN 2–3 versus no AKI, long-rank p = 0.014; AKIN 2–3 versus AKIN 1, long-rank p = 0.169.

Table 2. Predictive factors associated with AKI in LTx patients.

Predictive factor	Multivariate p Value	Multivariate adjusted^a p Value	Multivariate adjusted^a OR (95% CI)
Pre-LT hypertension	0.048	0.041	1.37 (0.06 to 2.68)
MBP	<0.001	<0.001	−0.06 (−0.08 to −0.04)
ECMO support	0.049	0.037	−1.26 (−2.44 to −0.08)
Duration of MV	0.019	0.022	0.05 (0.01 to 0.09)

Notes: ^aAdjust for age, gender, hypertension, perioperative MBP, inotropic support, aprotinin, mechanical ventilation, ECOM support, and sepsis.