title: Acute renal failure after lung transplantation: incidence, predictors and impact on perioperative morbidity and mortality.
abstract: The incidence, predictors and clinical significance of acute renal failure (ARF) after lung transplantation are not well described. We retrospectively collected data on 296 patients transplanted at our center between April 1992 and December 2000; follow-up was extended until December 2002. Patients were initially divided into two groups: ARF (doubling of baseline creatinine within 2 weeks after surgery) and NoARF. The ARF group was subdivided into ARFD (dialyzed) and ARFnD (not dialyzed). The incidence of ARF was 56% (166/296), but most cases were ARFnD (n = 143). Independent predictors of ARFD (n = 23) were: baseline GFR (OR 0.98, CI 0.96-0.99, p = 0.012), pulmonary diagnosis other than COPD (OR 6.80, CI 1.5-30.89, p = 0.013), mechanical ventilation > 1 d (OR 6.16, CI 1.70-22.24, p = 0.006) and parenteral amphotericin B use (OR 3.04, CI 1.03-8.98, p = 0.045). Both ARFnD and ARFD were associated with longer duration of mechanical ventilation, increased hospital stay and increased early mortality. One-year patient survival was 92.3%, 81.8% and 21.7% in the NoARF, ARFnD and ARFD groups, respectively (p < 0.0001). After controlling for important covariates, ARFD remained associated with an increased hazard of dying (HR 6.77, CI 4.00-11.44, p < 0.0001). In conclusion, ARF occurs commonly after lung transplantation and affects important clinical outcomes, especially when dialysis is required.
authors.affiliation: Duke University Medical Center, Department of Medicine, Division of Nephrology, Durham, NC 17710, USA. paulonrocha@alumni.duke.edu
authors.forename: Paulo N
authors.initials: PN
authors.lastname: Rocha
authors.forename: Ana T
authors.initials: AT
authors.lastname: Rocha
authors.forename: Scott M
authors.initials: SM
authors.lastname: Palmer
authors.forename: R Duane
authors.initials: RD
authors.lastname: Davis
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Smith
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality* / Q000473:pathology; D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011237:Predictive Value of Tests; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D000666:Amphotericin B; D003404:Creatinine