title: Acute renal failure following lung transplantation: risk factors, mortality, and long-term consequences.
abstract: OBJECTIVE
  Acute renal failure (ARF) frequently complicates lung transplantation. This study determined the prevalence, predictive factors, and consequences of ARF on long-term renal function and survival.
  
  
  METHODS
  One hundred and seventy-four lung transplantation recipients were divided into two groups based on the presence or absence of ARF defined as a 50% decrease in creatinine clearance from baseline (group I: 67 patients with ARF; group II: 107 patients without ARF). Multivariate analysis compared pre-operative, operative, and post-operative risk factors to assess predictive factors. Renal function over time was assessed by two-way repeated measures analysis of variance (ANOVA).
  
  
  RESULTS
  ARF developed in 67 (39%) of patients. Multivariate analysis identified aprotinin (OR 2.20 (1.11; 4.36), p=0.02) and double lung transplantation (OR 2.61 (1.32; 5.15), p=0.006) as risk factors for post-operative renal failure. At 5 years following transplant, creatinine clearance was similar between the two groups (group I CrCl: 73 ml s(-1); group II CrCl: 53 ml s(-1); p=0.54). Survival at 5 years was the same in the two groups. Multivariate analysis associated age at the time of transplantation (HR 1.030 (1.004; 1.057), p=0.02) and intensive care unit (ICU) length of stay (HR 1.029 (1.008; 1.051), p=0.007) with decreased survival.
  
  
  CONCLUSIONS
  The use of aprotinin and double lung transplantation are associated with ARF following lung transplantation. Age at the time of transplantation and a longer intensive care stay predict decreased survival. ARF after lung transplantation is not predictive of late renal dysfunction or decreased long-term survival.
authors.affiliation: Division of Thoracic Surgery, Centre Hospitalier de l'Université de Montréal, and Montreal Heart Institute Research Center, Université de Montréal, Montréal, Quebec, Canada.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Jacques
authors.forename: Ismail
authors.initials: I
authors.lastname: El-Hamamsy
authors.forename: Annik
authors.initials: A
authors.lastname: Fortier
authors.forename: Simon
authors.initials: S
authors.lastname: Maltais
authors.forename: Louis P
authors.initials: LP
authors.lastname: Perrault
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
authors.forename: Nicolas
authors.initials: N
authors.lastname: Noiseux
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ferraro
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000328:Adult; D007611:Aprotinin / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D003422:Critical Care; D005260:Female; D006490:Hemostatics / Q000009:adverse effects; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D006490:Hemostatics; D007611:Aprotinin; D003404:Creatinine