Early Implementation of Renal Replacement Therapy after Lung Transplantation Does Not Impair Long-Term Kidney Function in iPAH Patients.

In patients suffering from idiopathic pulmonary arterial hypertension (iPAH), cardiac function can be impaired in the early postoperative phase after lung transplantation as the chronically untrained left ventricle is prone to fail. Thus, restrictive fluid management is pivotal to unload the left heart. In our institution, continuous renal replacement therapy (CRRT) is implemented liberally, whenever a patient cannot be balanced negatively. It remains unclear whether such strategy impairs long-term kidney function. iPAH patients transplanted between 2000 and 2018 were included in this retrospective study. The influence of hemofiltration in the peri-operative phase on long-term outcomes was investigated. A total of 87 iPAH lung transplant recipients were included in this analysis. In 38 patients (44%) CRRT was started in the early postoperative period for a median of 16 days (3-45). In this group, urine production had significantly decreased and patients began to acquire a positive fluid balance, however, hemostatic functions of the kidney were still preserved at the time of CRRT initiation. All patients were successfully weaned from CRRT and fully recovered their kidney function at the time of hospital discharge (Figure 1). No difference in kidney function was found between CRRT and non-CRRT patients at 1, 3, and 5 years. Long-term survival was excellent with 10-year survival rates of 75%. Early implementation of CRRT for perioperative volume management does not impair long-term kidney function in iPAH recipients. Our data suggest that such a strategy leads to excellent long-term outcomes. [ABSTRACT FROM AUTHOR]