Background::Acute kidney injury (AKI) is a common and serious complication following lung transplantation (LTx), and it is associated with high mortality and morbidity. This study assessed the incidence of AKI after LTx and analyzed the associated perioperative factors and clinical outcomes.Methods::This retrospective study included all adult LTx recipients at the China-Japan Friendship Hospital in Beijing between March 2017 and December 2019. The outcomes were AKI incidence, risk factors, mortality, and kidney recovery. Multivariate analysis was performed to identify independent risk factors. Survival analysis was presented using the Kaplan-Meier curves.Results::AKI occurred in 137 of the 191 patients (71.7%), with transient AKI in 43 (22.5%) and persistent AKI in 94 (49.2%). AKI stage 1 occurred in 27/191 (14.1%), stage 2 in 46/191 (24.1%), and stage 3 in 64/191 (33.5%) of the AKI patients. Renal replacement therapy (RRT) was administered to 35/191 (18.3%) of the patients. Male sex, older age, mechanical ventilation (MV), severe hypotension, septic shock, multiple organ dysfunction (MODS), prolonged extracorporeal membrane oxygenation (ECMO), reintubation, and nephrotoxic agents were associated with AKI ( P < 0.050). Persistent AKI was independently associated with preoperative pulmonary hypertension, severe hypotension, post-operative MODS, and nephrotoxic agents. Severe hypotension, septic shock, MODS, reintubation, prolonged MV, and ECMO during or after LTx were related to severe AKI (stage 3) ( P < 0.050). Patients with persistent and severe AKI had a significantly longer duration of MV, longer duration in the intensive care unit (ICU), worse downstream kidney function, and reduced survival ( P < 0.050). Conclusions::AKI is common after LTx, but the pathogenic mechanism of AKI is complicated, and prerenal causes are important. Persistent and severe AKI were associated with poor short- and long-term kidney function and reduced survival in LTx patients.

Acute kidney injury;Adult lung transplantation;Incidence;Outcomes;Risk factors

Jing Lei;Chen Wenhui;Zhao Li;Guo Lijuan;Liang Chaoyang;Chen Jingyu;Wang Chen

Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;Department of Lung Transplantation, Centre of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China;National Center for Respiratory Medicine, Beijing 100029, China;Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing 100029, China;National Clinical Research Center for Respiratory Diseases, Beijing 100029, China;Wuxi Lung Transplant Center, Wuxi People’s Hospital affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, China

中华医学杂志（英文版）

[1]Jing Lei;Chen Wenhui;Zhao Li;Guo Lijuan;Liang Chaoyang;Chen Jingyu;Wang Chen-.Acute kidney injury following adult lung transplantation)[J].中华医学杂志（英文版）,2022(02):172-180

reintubation,nephrotoxic,prerenal

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