Acute Kidney Injury Within 72 Hours After Lung Transplantation: Incidence and Perioperative Risk Factors

Objective: To define the incidence and perioperative risk factors of acute kidney injury (AKI) within 72 hours after lung transplantation and clarify the relationship between postoperative AKI and outcome in patients undergoing lung transplantation. Design: A retrospective observational study. Setting: A tertiary care academic center. Participants: Fifty-four patients who underwent lung transplantation between January 2006 and March 2010. Interventions: None. Measurements and Main Results: After excluding 4 patients who died or required additional surgery during the first 72 hours after transplantation, 50 patients were included in the final analysis. Data were extracted from medical charts and electronic health record information system. Risk, injury, failure, loss, endstage (RIFLE) renal disease creatinine criteria were used for the diagnosis of AKI. AKI developed in 27 patients (54%) within 72 hours after transplantation. The incidence of AKI after double-lung transplantation was 87% compared to 40% following single-lung transplantation. The percentage of patients with intraoperative hypoxemia (SpO(2) < 90%) was significantly different between the groups (AKI, 59%; Non-AKI, 22%). Volume of hydroxyethyl starch was significantly higher in AKI patients (912 +/- 507 mL) than non-AKI patients (535 +/- 338 mL). Baseline estimated glomerular filtration rate (eGFR) was significantly higher in AKI patients (99 +/- 27 mL/min/1.73m(2)) than non-AKI patients (77 +/- 20 mL/min/1.73m(2)). Conclusions: AKI based on the RIFLE criteria following lung transplantation is common. Patients who developed AKI were more likely to have an episode of intraoperative hypoxemia and undergo a double-lung transplantation. Contrary to other published studies, patients with a higher preoperative eGFR were more likely to develop AKI in the authors' cohort. (C) 2014 Elsevier Inc. All rights reserved.