title: Incidence and outcomes of acute kidney injury following orthotopic lung transplantation: a population-based cohort study.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a serious complication following lung transplantation (LTx). We aimed to describe the incidence and outcomes associated with AKI following LTx.
  
  
  METHODS
  A retrospective population-based cohort study of all adult recipients of LTx at the University of Alberta between 1990 and 2011. The primary outcome was AKI, defined and classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, in the first 7 post-operative days. Secondary outcomes included risk factors, utilization of renal replacement therapy (RRT), occurrence of post-operative complications, mortality and kidney recovery.
  
  
  RESULTS
  Of 445 LTx recipients included, AKI occurred in 306 (68.8%), with severity classified as Stage I in 38.9% (n = 173), Stage II in 17.5% (n = 78) and Stage III in 12.4% (n = 55). RRT was received by 36 (8.1%). Factors associated with AKI included longer duration of cardiopulmonary bypass [per minute, odds ratio (OR) 1.003; 95% confidence interval (CI), 1.001-1.006; P = 0.02], and mechanical ventilation [per hour (log-transformed), OR 5.30; 95% CI, 3.04-9.24; P < 0.001], and use of cyclosporine (OR 2.03; 95% CI, 1.13-3.64; P = 0.02). In-hospital and 1-year mortality were significantly higher in those with AKI compared with no AKI (7.2 versus 0%; adjusted P = 0.001; 14.4 versus 5.0%; adjusted P = 0.02, respectively). At 3 months, those with AKI had greater sustained loss of kidney function compared with no AKI [estimated glomerular filtration rate, mean (SD): 68.9 (25.7) versus 75.3 (22.1) mL/min/1.73 m(2), P = 0.01].
  
  
  CONCLUSIONS
  By the KDIGO definition, AKI occurred in two-thirds of patients following LTx. AKI portended greater risk of death and loss of kidney function.
authors: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada Nephrology Department, Hospital Prof Dr Fernando Fonseca, Amadora, Portugal.
authors: Pedro
authors: P
authors: Fidalgo
authors: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors: Mohammed
authors: M
authors: Ahmed
authors: Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
authors: Steven R
authors: SR
authors: Meyer
authors: Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors: Dale
authors: D
authors: Lien
authors: Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
authors: Justin
authors: J
authors: Weinkauf
authors: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada Gastroenterology Department, Hospital Prof Dr Fernando Fonseca, Amadora, Portugal.
authors: Filipe S
authors: FS
authors: Cardoso
authors: Lung Transplant Program, Alberta Health Services, Edmonton, AB, Canada.
authors: Kathy
authors: K
authors: Jackson
authors: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors: Sean M
authors: SM
authors: Bagshaw
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000401:mortality; D000328:Adult; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: acute kidney injury; lung transplantation; mortality; population-based cohort study; renal replacement therapy