Severity of Acute Kidney Injury in the Post-Lung Transplant Patient Is Associated With Higher Healthcare Resources and Cost

Nguyen, Albert; Gabriel, Rodney A.; Golts, Eugene; Kistler, Erik B.; Schmidt, Ulrich

doi:10.1053/j.jvca.2017.02.004

Cited by 15 publications

(29 citation statements)

References 34 publications

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“…Thus, 26 cohort studies [10,11,13,14,19,21,24,28,29,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53] with 40,592 patients undergoing lung transplantation were identified. Figure 1 shows a flowchart outlining identification of papers for inclusion.…”

Section: Resultsmentioning

confidence: 99%

“…This leads to activation of the renin-angiotensin-aldosterone system (RAAS) and direct renal vasoconstriction, resulting in a reduction in RBF and GFR [56,60,61,62]. Furthermore, poorly controlled hemodynamics during lung transplant surgery can result in intraoperative hypotension, one of the most significant risk factors for the development of AKI after lung transplantation [10,24]. Currently, CPB remains a standard method used in lung transplantation for intraoperative cardiorespiratory support, especially in cases of poor hemodynamic tolerance or severe pulmonary arterial hypertension [63].…”

Section: Discussionmentioning

confidence: 99%

“…Since the first human lung transplant was performed in 1963, almost 55,000 lung transplantations have been performed worldwide, now with nearly 4600 lung transplantations performed annually [10]. Up to 68% of lung transplant recipients develop AKI, which has been associated with increased one-year mortality, length of hospital stay, higher resource utilization, and related health care burden [10,11,12,13,14,15,16,17,18,19,20,21,22]. Though survival following lung transplantation has improved over the past few decades, morbidity and mortality related to AKI after lung transplantation and resultant progressive CKD remain relatively high and is a cause for increasing concern [16,23,24,25].…”

Section: Introductionmentioning

confidence: 99%

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Acute Kidney Injury after Lung Transplantation: A Systematic Review and Meta-Analysis

Lertjitbanjong

Cheungpasitporn

O'Corragain

et al. 2019

JCM

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Background: Lung transplantation has been increasingly performed worldwide and is considered an effective therapy for patients with various causes of end-stage lung diseases. We performed a systematic review to assess the incidence and impact of acute kidney injury (AKI) and severe AKI requiring renal replacement therapy (RRT) in patients after lung transplantation. Methods: A literature search was conducted utilizing Ovid MEDLINE, EMBASE, and Cochrane Database from inception through June 2019. We included studies that evaluated the incidence of AKI, severe AKI requiring RRT, and mortality risk of AKI among patients after lung transplantation. Pooled incidence and odds ratios (ORs) with 95% confidence interval (CI) were obtained using random-effects meta-analysis. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42019134095). Results: A total of 26 cohort studies with a total of 40,592 patients after lung transplantation were enrolled. Overall, the pooled estimated incidence rates of AKI (by standard AKI definitions) and severe AKI requiring RRT following lung transplantation were 52.5% (95% CI: 45.8–59.1%) and 9.3% (95% CI: 7.6–11.4%). Meta-regression analysis demonstrated that the year of study did not significantly affect the incidence of AKI (p = 0.22) and severe AKI requiring RRT (p = 0.68). The pooled ORs of in-hospital mortality in patients after lung transplantation with AKI and severe AKI requiring RRT were 2.75 (95% CI, 1.18–6.41) and 10.89 (95% CI, 5.03–23.58). At five years, the pooled ORs of mortality among patients after lung transplantation with AKI and severe AKI requiring RRT were 1.47 (95% CI, 1.11–1.94) and 4.79 (95% CI, 3.58–6.40), respectively. Conclusion: The overall estimated incidence rates of AKI and severe AKI requiring RRT in patients after lung transplantation are 52.5% and 9.3%, respectively. Despite advances in therapy, the incidence of AKI in patients after lung transplantation does not seem to have decreased. In addition, AKI after lung transplantation is significantly associated with reduced short-term and long-term survival.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute Kidney Injury after Lung Transplantation: A Systematic Review and Meta-Analysis

Lertjitbanjong

Cheungpasitporn

O'Corragain

et al. 2019

JCM

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“…In addition, peri-operative pulmonary hypertension requiring intense cardioactive support and ECMO, represented an important contributing factor for post-operative kidney injury and PGD. The consequent renal failure requiring dialytic treatment is a well-recognized cause of difficult fluid and immunosuppression management, lung interstitial congestion, cardiovascular complications and superinfections (17).…”

Section: Discussionmentioning

confidence: 99%

Pushing the limits of reconditioning: extended normothermic lung perfusion in an extended criteria donor

Schiavon¹,

Zampieri²,

Marulli³

et al. 2018

J. Thorac. Dis

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“…Despite screening acute kidney injury, usually manifesting within 48 hours of LTx has been reported in over half of LTx recipients in some cohorts. 108 Treatment is largely supportive, without any change in the core immunosuppressive treatments. While the majority recovered within 3 to 4 weeks with conservative management, one in eight patients required renal replacement therapy.…”

Section: Acute Kidney Injurymentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease and Lung Transplantation

Greer

Welte

2020

Semin Respir Crit Care Med

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Lung transplantation (LTx) has been a viable option for patients with end-stage chronic obstructive pulmonary disease (COPD), with more than 20,000 procedures performed worldwide. Survival after LTx lags behind most other forms of solid-organ transplantation, with median survival for COPD recipients being a sobering 6.0 years. Given the limited supply of suitable donor organs, not all patients with end-stage COPD are candidates for LTx. We discuss appropriate criteria for accepting patients for LTx, as well as contraindications and exclusionary criteria. In the first year post-LTx, infection and graft failure are the leading causes of death. Beyond this chronic graft rejection—currently referred to as chronic lung allograft dysfunction—represents the leading cause of death at all time points, with infection and over time malignancy also limiting survival. Referral of COPD patients to a lung transplant center should be considered in the presence of progressing disease despite maximal medical therapy. As a rule of thumb, a forced expiratory volume in 1 second < 25% predicted in the absence of exacerbation, hypoxia (PaO2 < 60 mm Hg/8 kPa), and/or hypercapnia (PaCO2 > 50 mm Hg/6.6 kPa) and satisfactory general clinical condition should be considered the basic prerequisites for timely referral. We also discuss salient issues post-LTx and factors that impact posttransplant survival and morbidity such as infections, malignancy, renal insufficiency, and complications associated with long-term immunosuppression.

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Severity of Acute Kidney Injury in the Post-Lung Transplant Patient Is Associated With Higher Healthcare Resources and Cost

Cited by 15 publications

References 34 publications

Acute Kidney Injury after Lung Transplantation: A Systematic Review and Meta-Analysis

Acute Kidney Injury after Lung Transplantation: A Systematic Review and Meta-Analysis

Pushing the limits of reconditioning: extended normothermic lung perfusion in an extended criteria donor

Chronic Obstructive Pulmonary Disease and Lung Transplantation

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