Longitudinal assessment of renal function after lung transplantation for cystic fibrosis: transition from post-operative acute kidney injury to acute kidney disease and chronic kidney failure
| Autor: | Vittorio Scaravilli, Alessandra Merrino, Francesca Bichi, Fabiana Madotto, Letizia Corinna Morlacchi, Mario Nosotti, Alfredo Lissoni, Lorenzo Rosso, Francesco Blasi, Antonio Pesenti, Alberto Zanella, Giuseppe Castellano, Giacomo Grasselli |
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| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Settore MED/14 - Nefrologia
Settore MED/10 - Malattie dell'Apparato Respiratorio Settore MED/21 - Chirurgia Toracica Settore MED/41 - Anestesiologia Kidney Cystic fibrosis Acute kidney injury Acute kidney disease Chronic kidney disease Lung transplantation Risk Factors Nephrology Acute Disease Humans Kidney Failure Chronic Female Renal Insufficiency Chronic Retrospective Studies |
| Popis: | Introduction The clinical trajectory of post-operative acute kidney injury (AKI) following lung transplantation for cystic fibrosis is unknown. Methods Incidence and risk factors for post-operative AKI, acute kidney disease (AKD) and chronic kidney disease (CKD) were retrospectively analyzed in cystic fibrosis patients undergoing lung transplantation. Logistic regressions, Chi-square, Cuzick rank tests, and Cox-proportional hazard models were used. Results Eighty-three patients were included. Creatinine peaked 3[2–4] days after transplantation, with 15(18%), 15(18%), and 20(24%) patients having post-operative AKI stages 1, 2, and 3, while 15(18%), 19(23%) and 10(12%) developed AKD stage 1, stage 2 and 3, respectively. Higher AKI stage was associated with worsening AKD (p = 0.009) and CKD (p = 0.015) stages. Of the 50 patients with AKI, 32(66%) transitioned to AKD stage > 0, and then 27 (56%) to CKD stage > 1. Female sex, extracorporeal membrane oxygenation support as a bridge to lung transplant and at the end of the surgery, the use of intraoperative blood components, and cold-ischemia time were associated with increased risk of post-operative AKI and AKD. Higher AKI stage prolonged invasive mechanical ventilation (p = 0.0001), ICU stay (p = 0.0001), and hospital stay (p = 0.0001), and increased the incidence of primary graft dysfunction (p = 0.035). Both AKI and AKD stages > 2 worsened long-term survival with risk ratios of 3.71 (1.34–10.2), p = 0.0131 and 2.65(1.02–6.87), p = 0.0443, respectively. Discussion AKI is frequent in cystic fibrosis patients undergoing lung transplantation, it often evolves to AKD and to chronic kidney disease, thereby worsening short- and long-term outcomes. Graphical abstract |
| Databáze: | OpenAIRE |
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