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. 2024 Sep;38(9):e15457.
doi: 10.1111/ctr.15457.

Postoperative Fluid Accumulation is Associated With Underestimation of AKI Severity in Lung Transplant Recipients

Stefan Kuhnert  1   2 , Janine Sommerlad  1 , Henning Gall  1   2 , Max M Weder  3 , Matthias Wolff  4 , Sebastian Eberle  4 , Michael Sander  4 , Martin Reichert  5 , Christian Koch  4 , Ingolf Askevold  5 , Andreas Hecker  5 , Winfried Padberg  5 , Marlies Ostermann  6 , Ravindra Mehta  7 , Claudio Ronco  8   9   10 , Horst-Walter Birk  1 , Werner Seeger  1   2   11 , Konstantin Mayer  12 , Matthias Hecker  1   2 , Faeq Husain-Syed  1   8
Affiliations

Postoperative Fluid Accumulation is Associated With Underestimation of AKI Severity in Lung Transplant Recipients

Stefan Kuhnert et al. Clin Transplant. 2024 Sep.

Abstract

Background: Post-lung transplantation (LTx) fluid accumulation can lead to dilution of serum creatinine (SCr). We hypothesized that fluid accumulation might impact the diagnosis, staging, and outcome of posttransplant acute kidney injury (AKI).

Methods: In this retrospective study, we analyzed data from 131 adult LTx patients at a single German lung center between 2005 and 2018. We assessed the occurrence of AKI within 7 days posttransplant, both before and after SCr-adjustment for fluid balance (FB), and investigated its impact on all-cause mortality. Transient and persistent AKIs were defined as return to baseline kidney function or continuation of AKI beyond 72 h of onset, respectively.

Results: AKI was diagnosed in 58.8% of patients according to crude SCr values. When considering FB-adjusted SCr values, AKI severity was underestimated in 20.6% of patients, that is, AKI was detected in an additional 6.9% of patients and led to AKI upstaging in 23.4% of cases. Patients initially underestimated but detected with AKI only after FB adjustment had higher mortality compared to those who did not meet AKI criteria (hazard ratio [HR] 2.98; 95% confidence interval [CI] 1.06, 8.36; p = 0.038). Persistent AKI was associated with higher mortality than transient AKI, regardless of using crude or adjusted SCr values (p < 0.05). Persistent AKI emerged as an independent risk factor for mortality (HR 2.35; 95% CI 1.29, 4.30; p = 0.005).

Conclusion: Adjusting for FB and evaluating renal recovery patterns post-AKI may enhance the sensitivity of AKI detection. This approach could help identify patients with poor prognosis and potentially improve outcomes in lung transplant recipients.

Trial registration: ClinicalTrials.gov identifier: NCT03039959, NCT03046277.

Keywords: fluid balance; lung transplantation; persistent acute kidney injury; renal recovery; serum creatinine.

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References

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    1. M. G. S. Shashaty, C. M. Forker, T. A. Miano, et al., “The Association of Post‐Lung Transplant Acute Kidney Injury With Mortality Is Independent of Primary Graft Dysfunction: A Cohort Study,” Clinical Transplantation 33 (2019): e13678.
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