Influence of Intraoperative Hemodynamic Factors on the Development of Acute Kidney Injury in Lung Transplantation

Romano, Rosalba; Wong, Irene; Thakuria, Louit; Robertis, Fabio De; Bahrami, Toufan; Amrani, Mohamed; Kaul, Sundeep; Hall, Donna; Reed, Anna; Carby, Martin; Simón, A.; Marczin, Nándor

doi:10.1016/j.healun.2014.01.520

Cited by 1 publication

(6 citation statements)

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“…Confounding from an underlying inflammatory process related to the high use of mechanical support could also explain why this association of VIS and AKI was not seen in multivariate analyses. The authors found similar associations from prior studies 4,9,12,13,23 with AKI such as cumulative mechanical support, anemia, and intraoperative transfusions, further highlighting the association of intraoperative hemodynamic management on long-term mortality in patients undergoing lung transplantation.…”

Section: Discussionsupporting

confidence: 70%

“…These longer times also expose patients to longer durations of intraoperative mechanical support use, which further exposes patients to excessive fluid administration and is also a known predictor of AKI. 2 Hypotension, defined in various ways, has been demonstrated to be associated with AKI in other studies; 1,9,12,13 however, the authors surprisingly did not find this association in this investigation. Even when using different thresholds of hypotension and over short time intervals, univariate modeling failed to reveal any significant association.…”

Section: Discussioncontrasting

confidence: 63%

“…The association of intraoperative vasoactive medication use and postoperative AKI has been demonstrated in the univariate analyses of other studies. 9,12,13 The authors of these studies believed that this high incidence even in treated or normotensive patients could be attributable to an increased systemic inflammatory response and thus contributing not only to AKI but to PGD. 9 The use of mechanical circulatory support is much higher in this study cohort than in many similar institutions at approximately 65%.…”

Section: Discussionmentioning

confidence: 99%

“…The This alone, as demonstrated by previous works, results in a higher overall incidence of AKI. 10,13,23 The manner in which AKI was defined, based on AKIN criteria in any 72-h period, was extended into the postoperative period for 7 d as done in studies sharing characteristics with this one. 9,12 Although some nonsurgical postoperative events could be contributing to a higher number of patients with AKI (such as computerized tomography scans using contrast 24 ), the authors felt it to be prudent to include up to 7 d to capture late-occurring postoperative AKI and thus used this time interval for multivariate analyses.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,[5][6][7][8][9][10][11] The majority of studies examining risk factors for AKI have focused on preoperative comorbidities or surgical factors (such as increased surgical time or length of cardiopulmonary bypass [CPB]). 1,4,9,[12][13][14] The effects on intraoperative hemodynamic variables on AKI after lung transplantation have not been adequately studied. Unlike preoperative comorbidities, intraoperative blood pressure and ventilation are modifiable variables.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative Hypoxia Independently Associated With the Development of Acute Kidney Injury Following Bilateral Orthotopic Lung Transplantation

et al. 2021

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Original Clinical Science-General Background. Acute kidney injury (AKI) is a common postoperative complication in bilateral orthotopic lung transplant (BOLTx) recipients, but the contribution of intraoperative variables is not well defined. The authors hypothesized that intraoperative hypotension as well as hypoxia and vasopressor use would be associated with the development of postoperative AKI after BOLTx in patients without pre-existing renal dysfunction. Methods. The authors performed a retrospective analysis of patients undergoing BOLTx at a single center between 2013 and 2017. Intraoperative variables of hemodynamics included duration of mean arterial pressure <55, <60, and <65 mm Hg; duration of oxygen saturation <90%; and vasoactive-inotropic score (VIS). Associations between the occurrence of AKI and intraoperative hypotension, hypoxemia, and VIS were evaluated while controlling for significant confounding variables. Results. AKI occurred in 177 (72%) of 245 patients in postoperative days 1-7. Notable significant differences in univariate analyses included cumulative mechanical support time, maximum VIS, peripheral oxygen saturation <90% for >15 min, total minutes oxygen saturation <90%, and surgery duration in minutes. There was no significant difference in intraoperative hypotension measured as a duration >15 min for mean arterial pressure <55, <60, or <65 mm Hg. Multivariate logistic regression revealed preoperative creatinine (Odds ratio [OR], 7.77; confidence interval [CI], 1.96-30.83; P = 0.004), surgery duration (OR, 1.004; CI, 1.002-1.007; P = 0.002), and oxygen saturation (OR, 2.06; CI, 1.01-4.24; P = 0.049) <90% for >15 min to be independently associated with AKI. Conclusions. This study revealed that >15 min of intraoperative hypoxia was independently associated with postoperative AKI after BOLTx.

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Section: Discussionsupporting

confidence: 70%