Background: Acute kidney injury (AKI) is a frequent and severe complication after solid organ transplantation. In a retrospective analysis and afterwards in a prospective clinical trail we analysed AKI incidence, risk factors and outcome after lung transplantation.

Material and Methods: Retrospectively, we analysed 950 electronic patient files after lung transplantation between 1996 and 2010. Information on surgeries, blood transfusion and clinical outcome were recorded. AKI severity was defined by AKIN criteria in mild (AKIN-1), moderate (AKIN-2) and severe AKI (AKIN-3) based on by loss of eGFR, or increase of s-creatinine within the first 48 hours after surgery. CART analysis for risk predictors was performed.

Afterwards, a prospective clinical trial was performed. Patient urine and blood samples were collected prior to surgery at admission to ICU, after 6, 12, 24h, 3 and 7 days after surgery. Functional MRI to assess renal perfusion impairment was performed at day week 2.

Results: AKI incidence was 50% in the retrospective cohort and relevant risk factors for AKI were blood transfusions and pre-existing renal impairment.

Prospectively, 150 patients were included into the study, 65% of patients developed AKI. By antibody microarray we identified new biomarkers which correlated with AKI. Interestingly, haptoglobin expression was reduced in patients with AKI already prior to surgery. In functional MRI renal perfusion was significantly reduced in patients with AKI compared to healthy volunteers (228±64 vs 329±63 ml/(min*100g), p<0.01). Renal perfusion impairment correlated significantly with AKI severity and increase of s-creatinine.

Conclusion: AKI is an important complication after lung-tx. The combination of new biomarkers with advanced imaging techniques allows to estimate the severity of AKI and to identify new risk factors.

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