Acute Kidney Injury After Lung Transplantation - Incidence, Risk Factors and Mechanisms

Acute Kidney Injury After Lung Transplantation – Incidence, Risk Factors and Mechanisms

F. Gueler,¹ G. Warnecke,⁵ M. Peperhove,² M.-S. Jang,¹ C. Schroeder,³ S. Tewes,² B. Wiese,⁶ C. Fegbeutel,⁵ R. Lichtinghagen,⁷ B. Jüttner,⁸ F. Wacker,² D. Hartung,² B. Akerstrom,⁴ M. Gram,⁴ H. Haller,¹ A. Haverich,⁹ K. Hueper.²

¹Nephrology, Hannover Medical School, Hannover, Germany
²Radiology, Hannover Medical School, Hannover, Germany
³Proteomics, German Research Cancer Center, Heidelberg, Germany
⁴Physiology, Lund University, Lund, Sweden
⁵Thoracic and Cardiac Surgery, Hannover Medical School, Hannover, Germany
⁶Medical Statistics, Hannover Medical School, Hannover, Germany
⁷Laboratory Medicine, Hannover Medical School, Hannover, Germany
⁸Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
⁹Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.

Meeting: 2015 American Transplant Congress

Abstract number: B205

Keywords: Lung transplantation, Post-operative complications, Renal dysfunction, Renal injury

Session Information

Session Name: Poster Session B: Lung- All Topics

Session Type: Poster Session

Date: Sunday, May 3, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

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.

To cite this abstract in AMA style:

Gueler F, Warnecke G, Peperhove M, Jang M-S, Schroeder C, Tewes S, Wiese B, Fegbeutel C, Lichtinghagen R, Jüttner B, Wacker F, Hartung D, Akerstrom B, Gram M, Haller H, Haverich A, Hueper K. Acute Kidney Injury After Lung Transplantation – Incidence, Risk Factors and Mechanisms [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/acute-kidney-injury-after-lung-transplantation-incidence-risk-factors-and-mechanisms/. Accessed November 21, 2024.

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