Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Purpose: Elevated pre-operative pulmonary arterial pressures predict acute kidney injury (AKI) after lung transplant. It is unknown if the elevated pulmonary pressures predict recovery from these AKI events. Methods: We identified 464 lung allograft recipients transplanted between 1997 and 2009 with available preoperative mean pulmonary artery pressures (mPAP) measured a median (10th,90th) of 131 (0,283) days before transplant. We categorized patients as having pulmonary hypertension (PH) if mPAP was > 25mmHg (n=273, mean mPAP 35+-/11mmHg) vs. no PH if mPAP was < 25mmHg (n=191, mean mPAP 19+/-4mmHg). Only a minority of patients (n=17) had primary pulmonary arterial hypertension (PAH) as the etiology of lung disease. AKI was defined by > stage 1 AKI at any point within the first 14 postoperative days with at least a > 0.3mg/dl increase in creatinine from baseline according to the Acute Kidney Injury Network classification schema. Complete recovery from AKI was defined as return to baseline pre-AKI creatinine before hospital discharge. Results: AKI occurred in n=310 (67%) patients. The presence of PH pre-transplant significantly predicted AKI (OR 1.8, 95% CI 1.2,2.6). Of those patients with AKI, complete recovery occurred in n=106 (34%). On univariate analysis, the presence of PH pre-transplant predicted eventual recovery from AKI (OR 1.7, 95% CI 1.1, 2.9). Controlling for other factors that predicted recovery from AKI on univariate testing [age, transplant vintage, pre-operative mechanical ventilation (MV), PAH diagnosis, and AKI stage severity] covariates that remained independently associated with AKI recovery included older transplant vintage (OR 2.4, 95% CI 1.4,4.3), pre-operative MV (OR 13.1, 95% CI 2.4,108.6), PAH diagnosis (OR 5.5, 95% CI 1.4, 23.3), less severe AKI stage (OR 8.0, 95% CI 3.8,18.8), and pre-operative PH (OR 2.1, 95% CI 1.2, 3.8). Excluding n=17 PAH patients from the analysis did not change the results. Lack of recovery from AKI associated with death prior to hospital discharge (OR 2.7, 95% CI 1.0, 8.2). Conclusions: Higher pulmonary artery pressures independently predict both a higher risk of AKI and an increased chance of recovery from that AKI event. A potential unifying explanation is a predisposition to mild, self-limited hemodynamic renal insults in patients with pre-operative PH.
To cite this abstract in AMA style:Stephany B, Wehbe E, Budev M. Lung Transplant Patients With Elevated Baseline Pulmonary Arterial Pressures Are More Likely to Recover from Post-Transplant Acute Kidney Injury [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/lung-transplant-patients-with-elevated-baseline-pulmonary-arterial-pressures-are-more-likely-to-recover-from-post-transplant-acute-kidney-injury/. Accessed April 3, 2020.
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