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. 2023 Jul 31;15(7):3751-3763.
doi: 10.21037/jtd-23-256. Epub 2023 Jun 29.

Primary graft dysfunction grade correlates with acute kidney injury stage after lung transplantation

Takahide Toyoda  1 , Benjamin Louis Thomae  1 , Viswajit Kandula  1 , Adwaiy Jayant Manerikar  1 , Yuriko Yagi  1 , Emily Jeong Cerier  1 , Rade Tomic  2 , G R Scott Budinger  2 , Ankit Bharat  1   2 , Chitaru Kurihara  1
Affiliations

Primary graft dysfunction grade correlates with acute kidney injury stage after lung transplantation

Takahide Toyoda et al. J Thorac Dis. .

Abstract

Background: Primary graft dysfunction (PGD) and acute kidney injury (AKI) are major early complications of lung transplantation and are associated with increased mortality. Lung injury after PGD can contribute to renal dysfunction; however, the association between PGD and AKI severity has not been thoroughly investigated. We analyzed the association between PGD grading and AKI staging, and the impact of AKI on subsequent changes to chronic kidney disease (CKD), including glomerular filtration rate (GFR), over time.

Methods: This was a retrospective review of a single-center lung transplantation database between January 2018 and June 2022. AKI and GFR categories were classified according to the Kidney Disease: Improving Global Outcomes criteria. Spearman's and Kaplan-Meier tests were used to compare disease severity and assess survival.

Results: In a total of 206 patients: 119 (57.8%), 25 (12.1%), 34 (16.5%), and 28 (13.6%) had PGD grades 0, 1, 2, and 3, respectively; 96 (46.6%), 47 (22.8%), 27 (13.1%), and 36 (17.5%) had AKI stages 0, 1, 2, and 3, respectively. Twenty-one of the 28 patients (75.0%) with PGD grade 3 had AKI stage 3. There was a significant correlation between PGD grade and AKI stage (P<0.001). There was also a significant correlation between AKI stage and GFR category of CKD at 3, 6, 9, and 12 months after lung transplantation (all P<0.001). For all AKI stages, GFR categories worsened with postoperative time.

Conclusions: PGD grade was significantly correlated with AKI stage, and AKI stage was correlated with GFR categories of CKD.

Keywords: Lung transplantation; acute kidney injury (AKI); chronic kidney disease (CKD); primary graft dysfunction (PGD).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-256/coif). AB was supported by the National Institutes of Health (Nos. HL145478, HL147290, and HL147575). The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Kaplan-Meier analysis of overall survival after lung transplantation. (A) Survival rates among AKI stage groups. (B) Survival rates among PGD grade groups. AKI, acute kidney injury; PGD, primary graft dysfunction.
Figure 2
Figure 2
Correlation between PGD grade and AKI stage. (A) Distribution of the number of patients according to PGD and AKI stage. The heatmap shows the number of cases. (B) Spearman’s test was used to investigate the correlation between PGD grade and AKI stage. AKI, acute kidney injury; PGD, primary graft dysfunction.
Figure 3
Figure 3
Spearman’s test to investigate the correlation between AKI stage and GFR category of CKD criteria at 3 months (A), 6 months (B), 9 months (C), and 12 months (D) after lung transplantation. AKI, acute kidney injury; CKD, chronic kidney disease; GFR, glomerular filtration rate.
Figure 4
Figure 4
Linear mixed-effects models were used to investigate the time course of the GFR category of CKD after lung transplantation. (A) The entire cohort. (B) Cohort according to AKI stage. **, P<0.01; ***, P<0.001. AKI, acute kidney injury; CKD, chronic kidney disease; GFR, glomerular filtration rate; m, months.
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