Postoperative acute kidney injury requiring dialysis after lung transplantation: factors associated and long-term outcomes

Abstract OBJECTIVES Acute kidney injury (AKI) requiring dialysis after lung transplantation is a significant source of morbidity. This study investigates the incidence, mortality, and variables associated with the need for dialysis. METHODS This retrospective analysis included patients aged ≥15 years who underwent lung transplantation between 2014 and 2019 at three French institutions. Patients were grouped based on the need for dialysis in the postoperative period. Outcomes analyzed included the incidence of AKI requiring dialysis and short- and long-term mortality. We also examined the association between recipient, donor, and intraoperative variables and the need for dialysis. RESULTS The study population consisted of 478 patients, with a mean age of 49.7 (SD 14.3) years. Dialysis was required for 88 patients (18.4%). In multivariable logistic regression, recipient characteristics (diagnosis), donor characteristics (cardiac arrest), and intraoperative variables (total ischaemic time, norepinephrine dose at the end of the procedure, red blood cell and plasma transfusions) were independently associated with postoperative dialysis (p < 0.05). The median overall survival for patients requiring dialysis was 6.2 months (not reached for those without dialysis). Patients requiring dialysis had a higher risk of all-cause mortality (p < 0.01), with higher 30-day (29.5% vs 7.2%) and 1-year (63.6% vs 13.4%) mortality rates. CONCLUSIONS AKI requiring dialysis after lung transplantation is associated with significantly higher 30-day and long-term mortality. Identifying high-risk patients for postoperative renal failure requiring dialysis may improve long-term outcomes after lung transplantation.