Objectives
To determine the incidence and predictive factors of acute kidney injury (AKI) after
off-pump lung transplantation.
Design
A retrospective cohort study.
Setting
The operating room and intensive care unit.
Participants
Adult patients who underwent lung transplant without cardiopulmonary bypass or extracorporeal
membrane oxygenator between 2006 and 2016 at the Vanderbilt University Medical Center.
Interventions
None.
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).
Conclusions
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.
Key Words
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Article info
Publication history
Published online: September 17, 2021
Footnotes
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.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- 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).
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