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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]

Despite the increasing number of heart-kidney transplants being performed in recent years, renal failure after heart transplantation remains a pervasive recipient complication. The purpose of this study was to determine the predictors and outcomes of renal failure after heart transplantation in a contemporary cohort. This was a retrospective cohort study of all adults undergoing isolated heart transplantation in the 2018-2022 United Network for Organ Sharing database. Heart recipients were stratified into those experiencing postoperative renal failure requiring dialysis prior to discharge and those without renal failure. We used multivariable logistic regression to determine factors associated with postoperative renal failure and compared postoperative outcomes between groups. Of 10,545 patients undergoing heart transplantation, 1,485 (14%) experienced postoperative renal failure. Factors associated with increased odds of renal failure included: increasing creatinine (odds ratio, OR 2.09/mg/dL 95% CI 1.85-2.35), pretransplant dialysis (OR 4.83, 95% CI 3.46-6.74), ventilation (OR 1.86, 95% CI 1.28-2.69) or extracorporeal membrane oxygenation (OR 1.78, 95% CI 1.38-2.29) prior to transplant, and prior cardiac surgery (OR 1.41, 95% CI 1.25-1.59). Patients with renal failure following heart transplantation experienced markedly higher rates of primary graft dysfunction (5% vs 1%, P<0.001) and 30-day mortality as well as lower 1- and 3-year survival compared to those without renal failure (Figure). Renal failure occurred frequently in a contemporary cohort of isolated heart transplant patients, with limited modifiable risk factors for its development. Renal-sparing strategies need to be considered in the care of heart transplant recipients with these known risk factors. Despite the increasing number of heart-kidney transplants being performed, these data suggest that additional patients may benefit from dual organ transplantation. [ABSTRACT FROM AUTHOR]

While the outcomes of ECMO as a bridge to lung transplantation have been extensively studied, little is known regarding the use of post-operative ECMO in a contemporary cohort. The purpose of the study was the determine predictors and outcomes of post-operative ECMO in a national cohort. This was a retrospective cohort study of all adult lung transplantation recipients using the 2015 to 2022 United Network for Organ Sharing database. We used multivariable logistic regression to determine covariates associated with ECMO use at 72 hours following operation. Additionally, several outcomes including post-operative stroke, acute rejection and early (30-day and in-hospital) mortality as well as 1- and 5-year survival were compared between those requiring post-operative ECMO and all other lung recipients. Of 18,014 lung transplant recipients included in analysis, 1,430 (8%) required ECMO support following transplantation. Several recipient factors were associated with increased odds of post-operative ECMO use, including female gender (adjusted odds ratio, AOR 1.28, 95% CI 1.13-1.45), high BMI (AOR 1.05/kg/m2, 95% CI 1.04-1.06), preoperative ventilation (AOR 1.61, 95% CI 1.30-2.01) or dialysis (AOR 3.89, 95% CI 2.20-6.88), elevated serum bilirubin (AOR 1.08/mg/dL, 95% CI 1.04-1.12) and donor organ ischemic time > 4 hours (AOR 1.69, 95% CI 1.39-2.06). Those requiring post-operative ECMO experienced significantly higher rates of stroke (6% vs 2%, P<0.001), acute rejection (13% vs 7%, P<0.001) and early mortality along with decreased 1- and 5-year survival (Figure), compared to others. Patients requiring ECMO at 72 hours following lung transplantation experience markedly worse early outcomes and 5-year survival compared to all other lung recipients. Identification and management of pre-, intra-, and post-operative risk factors for severe PGD requiring post-operative ECMO may improve lung transplantation outcomes. [ABSTRACT FROM AUTHOR]

The new UNOS heart allocation policy prioritizes patients with percutaneous ventricular support devices over durable LVADs. We examined one-year survival of heart transplant recipients successfully bridged with Impella versus durable LVADs in the most recent era. We retrospectively reviewed all primary adult orthotopic heart transplant recipients in the UNOS registry between Jan 1, 2016 to June 12, 2020. Recipients were identified as having an isolated durable LVAD or Impella device at the time of transplant. Those bridged with ECMO, RVAD, BIVAD, or TAH were excluded. One-year survival was examined with the Kaplan Meier method and multivariable Cox proportional hazards regression. Of 10,492 heart transplant recipients in the study period, 4610(44%) were bridged with a durable LVAD and 158(2%) with Impella. Impella use increased following the UNOS allocation policy change (3% vs 1% of transplants, p<0.01) and a higher proportion were status 1 or 2 compared to those bridged with durable LVADs (96% vs 26%, p<0.01). Median days between listing and transplant were 40, 218, and 13 days for no MCS, durable LVAD, and Impella, respectively (p<0.01). Impella-bridged recipients were less likely to be obese (26% vs 41%, p<0.01), have diabetes (24% vs 31%, p<0.01), ischemic cardiomyopathy (28% vs 35%, p<0.01), prior cardiac surgery (27% vs 73%, p<0.01), and were more likely to be on inotropes at the time of transplant (65% vs 6%, p<0.01). On multivariate analysis, neither bridge with durable LVAD (aHR 1.25, 95% CI 0.97-1.62, p = 0.08) nor Impella (aHR 1.07, 95% CI 0.55-2.08, p=0.84) was associated with a difference in one-year survival following heart transplantation. Impella utilization as bridge to transplant has tripled in the current era of heart transplantation with no significant difference in one-year survival compared to those bridged with durable LVADs. Percutaneous LVAD platforms can be cautiously considered in the sickest patients requiring LVAD bridge to transplantation. [ABSTRACT FROM AUTHOR]