1. Renal Failure after Lung Transplantation: A Bump in the Road or a Grave Complication?
- Author
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Kim, S.T., Xia, Y., Ho, J.K., and Ardehali, A.
- Subjects
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KIDNEY failure , *KIDNEY transplantation , *LUNG transplantation , *RACE , *SURGICAL complications , *ODDS ratio - Abstract
Postoperative renal failure has been shown to be an important predictor of adverse outcomes after many surgical procedures. The purpose of this study was to examine the incidence of renal failure after lung transplantation and determine predictors and outcomes of renal failure in lung transplant recipients. We performed a retrospective cohort study of all adult patients undergoing lung transplantation from 2005 to 2022 using the United Network for Organ Sharing database. Multivariable logistic regression was used to determine factors associated with postoperative renal failure requiring dialysis. Postoperative complications and mortality were compared between patients experiencing postoperative renal failure and those without renal failure. Kaplan-Meier survival analysis was used to evaluate differences in survival between groups. Overall, 33,614 patients underwent lung transplantation during the study period, with 2,406 (7%) experiencing postoperative renal failure. Following adjustment, recipient factors associated with increased odds of renal failure included female sex (odds ratio, OR 1.10, 95% CI 1.00-1.21), black race (OR 1.59 (white reference), 95% CI 1.39-1.1.82), diabetes (OR 1.19, 95% CI 1.07-1.36), pre-operative dialysis (OR 9.45, 95% CI 6.18-14.44), higher lung allocation score (OR 1.01, 95% CI 1.01-1.01), ventilator use (OR 1.65, 95% CI 1.38-1.97) and ECMO use (OR 1.71, 95% CI 1.41-2.08). Patients with postoperative renal failure were more likely to experience acute rejection (14% vs 8%, P<0.001), had higher 30-day mortality and lower survival at 1- and 5-years following transplantation compared to those without renal failure (Figure). Renal failure after lung transplantation portends a grave prognosis, with limited modifiable risk factors. Further studies are needed to determine if renal sparing strategies in the peri-operative period may help alleviate this complication, and to identify patients who may benefit from lung-kidney transplantation. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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