*Purpose: Acute kidney Injury (AKI) occurs in more than 50% of patients after lung transplantation (LTx). Our purpose was to define incidence, risk factors and outcomes associated with AKI after LTx in a retrospective monocentric cohort study.

*Methods: We studied recipients of LTx (> 16 years of age) occurring at Ospedale Maggiore Policlinico Milano between Jan 1^st 2015 and Dec 31^st 2017. AKI was defined according to KDIGO classification, estimated Glomerular Filtration Rate (eGFR) was calculated according to CKD (Chronic Kidney Disease) Epidemiology Collaboration formula and CKD was defined by an eGFR< 60 ml/min per 1.73 m². Chi square, Fisher exact test, t.-test and logistic regression were used to define risk factors for AKI in the early post-surgical period and for CKD at 1 and 2 years after LTx; Kaplan Meyer model was applied to estimate AKI-related survival.

*Results: Half of the patients, among the 78 ones enrolled in our Center, was affected by cystic fibrosis. Median age at transplant was 43 years (27-55); median follow- up was 31 months (20-40). Survival rate was 80.77% at 1 year, 69.23% at 2 years and 66.67% on Dec 31^st 2019 (last follow-up). AKI occurred in 42 (53.85%) patients within the first week after LTx, respectively grade I and II in 12 each (15.38%) and grade III in 18 (23.08%) patients. Pre-transplant low albumin levels and hypertension were independently associated with AKI at univariate and multivariate (p= 0.004 and 0.005 respectively) analysis. Pre-transplant hypertension and ECMO-use during transplant surgery were independently associated with severe AKI in the multivariate analysis (p=0.028 and 0.043 respectively). Survival rate was significantly reduced in patients affected by AKI (p=0.035); this observation became strongly significant when only grade I and II AKI were considered (p=0.0071). CKD was present in 38.10% of patients at 1 year and 35.18% at 2 years. Several risk factors were related to the occurrence of CKD at 1 and 2 years after LTx at univariate analysis, but only grade III AKI was independently associated with CKD at multivariate one (p= 0.008 for 1 year-CKD, p=0.012 for 2 year-CKD).

*Conclusions: In our cohort, AKI after LTx occurred in about half of the patients and was predicted by history of hypertension, low albumin levels and hemodynamic instability during the surgery. Even mild forms of AKI, often clinically underestimated, were strongly associated with reduced survival in LTx patients. Severe forms of AKI were predictive of occurrence of long-term CKD.

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