Acute Kidney Injury after Lung Transplantation: A Systematic Review and Meta-Analysis

Abstract

Background: Lung transplantation has been increasingly performed worldwide and is considered an effective therapy for patients with various causes of end-stage lung diseases. We performed a systematic review to assess the incidence and impact of acute kidney injury (AKI) and severe AKI requiring renal replacement therapy (RRT) in patients after lung transplantation.

Methods: A literature search was conducted utilizing Ovid MEDLINE, EMBASE, and Cochrane Database from inception through June 2019. We included studies that evaluated the incidence of AKI, severe AKI requiring RRT, and mortality risk of AKI among patients after lung transplantation. Pooled incidence and odds ratios (ORs) with 95% confidence interval (CI) were obtained using random-effects meta-analysis. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42019134095).

Results: A total of 26 cohort studies with a total of 40,592 patients after lung transplantation were enrolled. Overall, the pooled estimated incidence rates of AKI (by standard AKI definitions) and severe AKI requiring RRT following lung transplantation were 52.5% (95% CI: 45.8-59.1%) and 9.3% (95% CI: 7.6-11.4%). Meta-regression analysis demonstrated that the year of study did not significantly affect the incidence of AKI (p = 0.22) and severe AKI requiring RRT (p = 0.68). The pooled ORs of in-hospital mortality in patients after lung transplantation with AKI and severe AKI requiring RRT were 2.75 (95% CI, 1.18-6.41) and 10.89 (95% CI, 5.03-23.58). At five years, the pooled ORs of mortality among patients after lung transplantation with AKI and severe AKI requiring RRT were 1.47 (95% CI, 1.11-1.94) and 4.79 (95% CI, 3.58-6.40), respectively.

Conclusion: The overall estimated incidence rates of AKI and severe AKI requiring RRT in patients after lung transplantation are 52.5% and 9.3%, respectively. Despite advances in therapy, the incidence of AKI in patients after lung transplantation does not seem to have decreased. In addition, AKI after lung transplantation is significantly associated with reduced short-term and long-term survival.

Keywords: acute kidney injury; epidemiology; incidence; lung transplantation; meta-analysis; transplantation.

Figure 1

Outline of our search methodology. AKI, Acute kidney injury.

Figure 2

Forest plots of the included studies evaluating incidence rates of AKI after lung transplantation. AKI, Acute kidney injury.

Figure 3

Forest plots of the included studies evaluating incidence rates of AKI requiring RRT after lung transplantation. AKI, Acute kidney injury; RRT, renal replacement therapy.

Figure 4

Meta-regression analyses showed that year of study did not significantly affect (A) the incidence of AKI (p = 0.11) and (B) severe AKI requiring RRT (p = 0.54) among patients after lung transplantation. AKI, acute kidney injury; RRT, renal replacement therapy.

Figure 5

Forest plots of the included studies evaluating hospital mortality of (A) AKI and (B) AKI requiring RRT after lung transplantation. AKI, acute kidney injury; RRT, renal replacement therapy.