Impact of Postoperative Continuous Renal Replacement Therapy in Lung Transplant Recipients

Abstract

Background. Acute kidney injury (AKI) is a common complication after lung transplant (LTx), and continuous renal replacement therapy (CRRT) is increasingly of use to critically ill patients who have developed AKI. However, the optimal timing or threshold of kidney impairment for which to commence CRRT after LTx has been uncertain. There has also been limited information on the impact of CRRT among LTx recipients (LTRs) introduced in the early posttransplant period on survival, graft function, and renal function. We aimed to review LTRs who developed AKI requiring CRRT postoperatively and followed their long-term outcomes at Tohoku University Hospital (TUH). Methods. Medical records of consecutive patients who underwent LTx at TUH between 2000 and 2018 were reviewed, with follow-up to 2019 inclusive. Results. Although mortality in those who required CRRT (n = 21) was increased versus those who did not require CRRT (n = 85)( P = 0.024), conditional survival beyond 3-month posttransplant was not affected ( P = 0.131). Additionally, the cumulative incidence of chronic lung allograft rejection ( P = 0.160) and the development of chronic kidney disease ( P = 0.757) were not significant between groups. Conclusions. The initiation of CRRT posttransplant may be a useful strategy to preserve cardiac and optimize volume management among critically ill patients.

Letermovir prophylaxis for cytomegalovirus in lung-transplant recipients: a comprehensive study with literature review of off-label use and real-world experiences

“…In situations where tacrolimus or mycophenolic mofetil cannot be tolerated, cyclosporine or azathioprine, respectively, is substituted [5]. Prophylaxis involving antimicrobials not confined to CMV [6][7][8], histocompatibility testing [5], and the comprehensive management of LTx recipients [9,10] have been previously reported. The overall post-transplantation management is comparable between TUH and Kyoto University Hospital (KUH).…”

Native-lung complications following single-lung transplantation for interstitial lung disease: an in-depth analysis

“…The analysis excluded recipients who had undergone BLTx ( n = 61). It is worth noting that prior studies have documented the transplant registry in Japan [ 8 ], intraoperative management, and chronic phase care [ 9 , 10 ], immunosuppressive therapy [ 11 ], histocompatibility testing after LTx [ 12 ], and antimicrobial prophylaxis [ 9 , 13 ]. The diagnosis of acute exacerbation of ILD in the native lung following SLTx was established on the basis of the emergence of new ground-glass opacities exclusively within the native lung post-discharge from the intensive care unit (ICU), explicitly excluding cases associated with heart failure [ 14 ].…”

Efficacy and safety of mRNA SARS-CoV-2 vaccines in lung transplant recipients

“…The study group included LTX recipients who were 6 months out from transplantation and followed at TUH. LTX indications [ 4 ], immunosuppression [ 5 ], histocompatibility testing [ 6 ], antimicrobial prophylaxis [ 7 ] and overall management [ 8 ] after transplantation have been previously described. Plasma mycophenolate concentration was measured based on the 12-h area under the concentration-time curve (AUC0-12) by a three time-point (C1, C4, and C8) sampling strategy [ 9 ].…”