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. 2022 Feb;36(2):e14468.
doi: 10.1111/ctr.14468. Epub 2021 Sep 12.

Postoperative acute kidney injury and renal replacement therapy after DCD lung transplantation

Alessandra Verzelloni Sef  1 , Davorin Sef  2 , Vladimir Trkulja  3 , Binu Raj  2 , Nicholas James Lees  1 , Christopher Walker  1 , Ian McGovern  1 , Jerry Mitchell  1 , Fabio De Robertis  2 , Ulrich Stock  2
Affiliations

Postoperative acute kidney injury and renal replacement therapy after DCD lung transplantation

Alessandra Verzelloni Sef et al. Clin Transplant. 2022 Feb.

Abstract

Acute kidney injury (AKI) after lung transplantation (LTx) is a common complication. We aimed to assess whether donation after circulatory death (DCD) is associated with an increased risk of AKI and renal replacement therapy (RRT) in the early postoperative period compared to the donation after brain death (DBD). Retrospective data on a cohort (N = 95) of LTx patients (DCD n = 17, DBD n = 78) characterized by no use of ex-vivo lung perfusion were analyzed for the incidence of AKI within 30 postoperative days and incidence of RRT within 7 and 30 days. After optimal full matching, an imbalance remained between the DCD and DBD patients in respect to intraoperative use of cardiopulmonary bypass (CPB). Therefore, a further subset (n = 77) was defined that excluded CPB patients, and matching was repeated (DCD n = 13 vs. DBD n = 63) resulting in a fair balance on a range of preoperative characteristics and intraoperative use of ECMO. In both matched subsets, DCD was associated with around twice higher risk of AKI and RRT within 7 and 30 postoperative days. In conclusion, data suggest that DCD could be associated with worse early renal outcomes in a subset of LTx patients and justify further studies on the topic in order to refine further renal care pathways perioperatively.

Keywords: acute kidney injury; donation after circulatory death; lung transplantation; renal replacement therapy.

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References

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