Transplantation: Preconditions and Outcomes in Lung Transplantation |

Right Ventricular Dysfunction and Acute Kidney Injury After Lung Transplantation FREE TO VIEW

Mrunal Patel, MD; Sana Quddus, MD; Lara Bakhos, MD; Eugene Brailovsky, MD
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Loyola University Medical Center, Chicago, IL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1311A. doi:10.1016/j.chest.2016.08.1427
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SESSION TITLE: Preconditions and Outcomes in Lung Transplantation

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: While chronic kidney disease has been well described after lung transplantation, few studies exist looking at acute kidney injury (AKI) immediately in the postoperative period. In a retrospective cohort study, patients with AKI after lung transplantation requiring renal replacement therapy were shown to have significantly higher pulmonary artery pressures. We hypothesized that this group of patients may have been more susceptible to developing AKI if they had decreased right ventricular function preoperatively.

METHODS: We retrospectively reviewed all patients that underwent lung transplantation at Loyola University Medical Center from January 1, 2014 to December 31, 2015. We examined the incidence of AKI within 30 days of lung transplantation and associated risk factors, as well as mortality. AKI was defined by the risk, injury, failure, loss, end stage (RIFLE) renal disease criteria, where two-fold elevation in creatinine was required. Preoperative echocardiograms were reviewed to see if there were any signs of reduced right ventricular function, and preoperative right heart catheterization (RHC) results were reviewed to look for signs of preoperative pulmonary hypertension.

RESULTS: 94 patients received lung transplantation our center during the study period, of which 81 patients were included in the final analysis. 32 patients (39.5%) developed AKI within 30 days of transplantation. There were 2 (7.1%) patients with reduced right ventricular function that developed AKI, compared to 6 (14.6%) out of 49 patients (p = 0.458). Patients that developed AKI were more likely to have undergone bilateral lung transplantation [25 (78.1%) vs 21 (42.9%) out of 49 patients that did not develop AKI; p = 0.003). Operative risk factors that are associated with higher incidence of AKI are operative time (581.5±136.9 vs. 517.2±126.2 minutes; p = 0.033) and need for cardiopulmonary bypass [12 (37.5%) vs 7 (14.3%) patients; p = 0.030]. Postoperatively, patients with mechanical ventilation for greater than 1 day [20 (62.5%) vs 13 (26.5%) patients; p = 0.018], elevated PA pressures with need for inhaled nitric oxide [30 (37.0%) vs 17 (53.1%); p = 0.020], and need for inotropes >2 days postoperatively [20 (24.7%) vs 14 (43.8%); p = 0.003] had a higher incidence of AKI. There was no significant difference in 30 day and 1 year mortality between patients that developed AKI and those that did not.

CONCLUSIONS: Reduced preoperative right ventricular function was not associated with increased risk of AKI postoperatively from lung transplantation surgery. Patients with AKI had a trend towards higher mean pulmonary artery pressures preoperatively (26.9±9.9 vs. 29.3±10.3; p = 0.083), however this difference did not achieve statistical significance. Patients with elevated pulmonary artery pressures postoperatively requiring inhaled nitric oxide did have significantly higher incidence of AKI after lung transplantation.

CLINICAL IMPLICATIONS: The presence of right ventricular dysfunction does not increase the risk of developing acute kidney injury after lung transplantation.

DISCLOSURE: The following authors have nothing to disclose: Mrunal Patel, Sana Quddus, Lara Bakhos, Eugene Brailovsky

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