title: Influence of hemodialysis on clinical outcomes after lung transplantation.
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.
  
  
  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.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA 22908-0679, USA.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Hennessy
authors.forename: Jacob R
authors.initials: JR
authors.lastname: Gillen
authors.forename: Tjasa
authors.initials: T
authors.lastname: Hranjec
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Kozower
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
authors.forename: Christine L
authors.initials: CL
authors.lastname: Lau
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D000328:Adult; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Acute kidney injury; Dialysis; Lung; Mortality; Outcomes; Transplantation