Influence of hemodialysis on clinical outcomes after lung transplantation

• Published in: The Journal of surgical research Vol. 183; no. 2; pp. 916 - 921
• Main Authors: Hennessy, Sara A., MD, Gillen, Jacob R., MD, Hranjec, Tjasa, MD, MS, Kozower, Benjamin D., MD, MPH, Jones, David R., MD, Kron, Irving L., MD, Lau, Christine L., MD, MBA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2013
• Subjects: Acute kidney injury; Acute Kidney Injury - epidemiology; Acute Kidney Injury - mortality; Acute Kidney Injury - therapy; Adult; Dialysis; Disease Progression; Female; Humans; Incidence; Kaplan-Meier Estimate; Lung; Lung Transplantation; Male; Middle Aged; Mortality; Outcome Assessment, Health Care; Outcomes; Postoperative Complications - epidemiology; Postoperative Complications - mortality; Postoperative Complications - therapy; Prognosis; Renal Dialysis; Retrospective Studies; Surgery; Survival Rate; Transplantation; Treatment Outcome; Transplantation; Dialysis; Lung; Acute kidney injury; Mortality; Outcomes
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2013.02.008

Abstract Background Chronic renal failure after lung transplantation is associated with significant morbidity. However, the significance of acute kidney injury (AKI) after lung transplantation remains unclear and poorly studied. We hypothesized that hemodialysis (HD)-dependent AKI after lung transplantation is associated with significant mortality. Materials and methods We performed a retrospective review of all patients undergoing lung transplantation from July 1991 to July 2009 at our institution. Recipients with AKI (creatinine > 3 mg/dL) were identified. We compared recipients without AKI versus recipients with and without HD-dependent AKI. Kaplan-Meier survival curves were compared by log rank test. Results Of 352 lung transplant recipients reviewed at our institution, 17 developed non–HD-dependent AKI (5%) and 16 developed HD-dependent AKI (4.6%). Cardiopulmonary bypass was significantly higher in patients with HD-dependent AKI. None of the recipients who required HD had recovery of renal function. The 30-day mortality was significantly greater in recipients requiring HD (63% versus 0%; P < 0.0001). One-year mortality after transplantation was significantly increased in recipients with HD-dependent AKI compared with those with non–HD-dependent AKI (87.5% versus 17.6%; P < 0.001). Conclusions Hemodialysis is associated with mortality after lung transplantation. Fortunately, AKI that does not progress to HD commonly resolves and has a better overall survival. Avoidance, if possible, of cardiopulmonary bypass may attenuate the incidence of AKI. Aggressive measures to identify and treat early postoperative renal dysfunction and prevent progression to HD may improve outcomes after lung transplantation.