E Atchade1, S Barour2, A Tran-Dinh3, S Jean-Baptiste2, S Tanaka4, P Tashk2, A Snauwaert2, B Lortat-Jacob2, G Mourin5, P Mordant6, Y Castier6, H Mal5, C De Tymowski7, P Montravers8. 1. Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Bichat-Claude Bernard, Département d'Anesthésie Réanimation, Paris, France. Electronic address: enora.atchade@aphp.fr. 2. Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Bichat-Claude Bernard, Département d'Anesthésie Réanimation, Paris, France. 3. Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Bichat-Claude Bernard, Département d'Anesthésie Réanimation, Paris, France; Laboratory for Vascular Translational Science, Inserm U1148, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France. 4. Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Bichat-Claude Bernard, Département d'Anesthésie Réanimation, Paris, France; Université de la Réunion, Inserm Unité Mixte de Recherche 1188 Diabète Athérothrombose, Réunion Ocean Indien, Saint Denis de la Réunion, France. 5. Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Bichat-Claude Bernard, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France. 6. Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Bichat-Claude Bernard, Service de Chirurgie Vasculaire, Thoracique et Transplantation, Paris, France. 7. Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Bichat-Claude Bernard, Département d'Anesthésie Réanimation, Paris, France; Inserm U1149 Immunorecepteur et Immunopathologie rénale, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France. 8. Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Bichat-Claude Bernard, Département d'Anesthésie Réanimation, Paris, France; Inserm, Unité Mixte de Recherche 1152, Paris, France.
Abstract
BACKGROUND: Acute kidney injury (AKI) is associated with increased short-term and long-term mortality and morbidity after lung transplantation (LT). The primary objective of this study was to analyze the perioperative factors associated with AKI according to Kidney Disease: Improving Global Outcome (KDIGO) criteria during hospitalization in an intensive care unit (ICU) after LT. METHODS: This was a single-center, observational, prospective study. AKI was defined according to KDIGO criteria. Results are expressed as median, interquartile range, absolute numbers, and percentages. Statistical analyses were performed using χ2 test, Fisher exact test, and Mann-Whitney U test. P < .05 was considered to be significant. Multivariate analysis was performed to identify independent risk factors. RESULTS: Between January 2016 and April 2018, 94 patients underwent LT (70% bilateral LT). AKI occurred during ICU stay in 46 patients (49%). KDIGO 1 AKI was observed in 16 patients (17%), KDIGO 2 in 14 patients (15%), and KDIGO 3 in 16 patients (17%), including 12 patients (75%) who required renal replacement therapy. AKI occurred before the fifth day after surgery for 38 patients (82% of the AKI patients). On multivariate analysis, independent factors associated with AKI were bilateral LT and mechanical ventilation >3 days (odds ratio [OR] 4.26, 95% confidence interval [CI] [1.49; 13.63] P = .010 and OR 5.56 [1.25; 11.47] P = .018, respectively). AKI and the need for renal replacement therapy were significantly associated with ICU mortality, 28-day mortality, and 1-year mortality. CONCLUSION: AKI is common during ICU stay after LT, especially after bilateral LT, and is associated with prolonged mechanical ventilation and increased short-term and long-term mortality.
BACKGROUND:Acute kidney injury (AKI) is associated with increased short-term and long-term mortality and morbidity after lung transplantation (LT). The primary objective of this study was to analyze the perioperative factors associated with AKI according to Kidney Disease: Improving Global Outcome (KDIGO) criteria during hospitalization in an intensive care unit (ICU) after LT. METHODS: This was a single-center, observational, prospective study. AKI was defined according to KDIGO criteria. Results are expressed as median, interquartile range, absolute numbers, and percentages. Statistical analyses were performed using χ2 test, Fisher exact test, and Mann-Whitney U test. P < .05 was considered to be significant. Multivariate analysis was performed to identify independent risk factors. RESULTS: Between January 2016 and April 2018, 94 patients underwent LT (70% bilateral LT). AKI occurred during ICU stay in 46 patients (49%). KDIGO 1 AKI was observed in 16 patients (17%), KDIGO 2 in 14 patients (15%), and KDIGO 3 in 16 patients (17%), including 12 patients (75%) who required renal replacement therapy. AKI occurred before the fifth day after surgery for 38 patients (82% of the AKIpatients). On multivariate analysis, independent factors associated with AKI were bilateral LT and mechanical ventilation >3 days (odds ratio [OR] 4.26, 95% confidence interval [CI] [1.49; 13.63] P = .010 and OR 5.56 [1.25; 11.47] P = .018, respectively). AKI and the need for renal replacement therapy were significantly associated with ICU mortality, 28-day mortality, and 1-year mortality. CONCLUSION:AKI is common during ICU stay after LT, especially after bilateral LT, and is associated with prolonged mechanical ventilation and increased short-term and long-term mortality.