To determine the incidence and predictive factors of acute kidney injury (AKI) after off-pump lung transplantation.
A retrospective cohort study.
The operating room and intensive care unit.
Adult patients who underwent lung transplant without cardiopulmonary bypass or extracorporeal membrane oxygenator between 2006 and 2016 at the Vanderbilt University Medical Center.
Measurements and Main Results
The presence of postoperative AKI was assessed by the Kidney Disease: Improving Global Outcomes criteria in the first seven postoperative days. Multivariate logistic regression analysis was used to determine the independent predictive factors of AKI. One hundred forty-eight patients were included in the final analysis, of whom 63 (42.6%) subsequently developed AKI: 43 (29.0%) stage 1, ten (6.8%) stage 2, and ten (6.8%) stage 3. Patients who had AKI had a longer hospital length of stay (12 days [interquartile range (IQR): 10-17] vs ten days [IQR: 8-12], p < 0.001). For every one-year increase in age, the odds of AKI decreased by 8% (odds ratio [OR] 0.92, 95% confidence interval [CI]: 0.87-0.98, p = 0.008). The odds of having AKI in patients with bilateral lung transplant was lower than patients with unilateral transplant (OR 0.09, 95% CI: 0.01-0.63, p = 0.015). Additionally, a diagnosis of chronic obstructive pulmonary disease increased the odds of AKI by four-fold compared with a diagnosis of idiopathic pulmonary fibrosis (OR 4.73, 95% CI: 1.44-15.56, p = 0.011).
AKI is a common complication after off-pump lung transplantation and is associated with increased hospital length of stay. Younger age, unilateral lung transplant, and diagnosis of chronic obstructive pulmonary disease are independently associated with AKI.
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Published online: September 17, 2021
Dr. Liang attests to the integrity of the submitted work and that no undisclosed authors contributed to the manuscript.
Support for the project described was provided solely from institutional and/or departmental sources.
© 2021 Elsevier Inc. All rights reserved.
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- Predicting the Price of the Pump: Examining the Incidence and Predictive Factors of Acute Kidney Injury Following Off-Pump Lung TransplantationJournal of Cardiothoracic and Vascular AnesthesiaVol. 36Issue 1
- PreviewFAMED ECONOMIST THOMAS SOWELL once noted that “there are no solutions, only trade-offs,” and this adage rings true in the current debate regarding the best approach for intraoperative utilization of extracorporeal life support (ECLS) in lung transplantation.1 Current literature reports a nearly even distribution of utilization of some form of ECLS intraoperatively versus no support at all,2 and a recent survey reports significant variability in the usage of ECLS types including cardiopulmonary bypass or extracorporeal membrane oxygenation (ECMO).