Short-term and long-term outcomes of acute kidney injury after lung transplantation.

The effect of acute kidney injury (AKI) after lung transplantation has been described infrequently and with inconsistent results. Using a newly adopted and validated definition of AKI proposed by the Acute Kidney Injury Network (AKIN), we examined the incidence of AKI and associated renal morbidity and short-term and long-term mortality. We retrospectively evaluated data of 657 patients who underwent lung transplantation from 1997 to 2009. Outcomes analyzed were the incidence of AKI, as defined and categorized into 3 stages according to creatinine criteria from the AKIN classification (AKIN 1, AKIN 2, and AKIN 3), cumulative incidence of chronic kidney disease (CKD), as defined by an estimated glomerular filtration rate ≤ 29 ml/min/1.73 m(2), and/or the onset of end-stage renal disease, as defined by the need for renal replacement therapy for 8 weeks with no recovery on follow-up or need for kidney transplant, and long-term mortality. We identified 424 patients (65%) who had at least 1 AKI (309 [47%] AKIN 1 and 115 [17%] AKIN 2-3) event in the first 2 weeks after transplantation. At 1 year, the cumulative incidence of CKD was 5.8%, 12.8%, 24.5 % in the no-AKI, AKIN 1, and AKIN 2-3 patients, respectively. After a median follow-up of 2.2 years, 277 (42%) died. One-year patient survival was 91%, 82%, 66% in the no-AKI, AKIN 1, and AKIN 2-3 patients, respectively. Adjusting for age, sex, race, type and cause of lung transplant, diabetes, and hypertension, the hazard ratio for death was 1.7 (95% confidence interval, 1.2-2.2; p = 0.0002) for AKIN 1 and 2.9 (95% confidence interval, 1.7-3.7; p < 0.001) for AKIN 2-3. AKI is a common complication after lung transplantation and is associated with increased risk of CKD and all cause-mortality on long-term follow-up.

Wehbe E ，Brock R ，Budev M ，Xu M ，Demirjian S ，Schreiber MJ Jr ，Stephany B ... -  《-》

Strong impact of acute kidney injury on survival after liver transplantation.

Acute kidney injury (AKI) is a major complication in orthotopic liver transplantation (OLT). In an evaluation of Acute Kidney Injury Network (AKIN) criteria in liver transplanted patients, we retrospectively analyzed the usefulness of these criteria to predict survival of 193 consecutive patients at a single center who underwent primary OLT for clinical parameters and peak AKI. Postoperative AKI according to AKIN occurred in 60.1% of the patients, namely, stages 1, 2, and 3 in 30%, 13% and 17.1% respectively. Using multivariate logistic regression, AKIN stage 1 and 2 AKI were independently associated with the pre-OLT Model for End-Stage Liver Disease (MELD) score and age, while stage 3 AKI was independently associated with MELD and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. The 28-day and 1-year mortality post-OLT of AKI patients were 15.5% and 25.9% respectively compared with 0% and 3.9% among non-AKI patients (P < .05 for both). The survival rates of non-AKI and stages 1, 2, and 3 AKI subjects were 96%, 85.5%, 84%, and 45.3%, respectively. Cox regression analysis showed independent risk factors for mortality during the first year after transplantation to include post-OLT AKI (12.1; P < .05), post-OLT infection (HR 4.7; P < .01), pre-OLT hypertension (HR 4.4; P < .01) hazard ratio [HR] and post-OLT APACHE II ≥10 (HR 3.6; P < .05). We concluded that AKI as defined by the AKIN criteria is a major complication of OLT linked to a poor outcomes. It remains to be evaluated whether aggressive perioperative therapy to prevent AKI can improve survival among OLT patients.

Zhu M ，Li Y ，Xia Q ，Wang S ，Qiu Y ，Che M ，Dai H ，Qian J ，Ni Z ，Axelsson J ，Yan Y ... -  《-》

A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients.

The pediatric-modified Risk, Injury, Failure and Loss, and End-Stage (pRIFLE) criteria and a different but conceptually similar system termed Acute Kidney Injury Network (AKIN) were created to standardize the definition of acute kidney injury (AKI) in children. Kidney Disease: Improving Global Outcomes (KDIGO) currently recommends a combination of AKIN and pRIFLE in AKI. This study aimed to compare the three classifications for predicting AKI in pediatric patients undergoing cardiac operations. We analyzed the prospectively collected data of 1,489 consecutive pediatric patients undergoing cardiac operations between January 2004 and December 2008. AKI presence and severity was assessed for each classification using the change in serum creatinine and estimated creatinine clearance levels calculated by the Schwartz equation. AKI was present in 285 (20%), 481 (34%), and 409 (29%) patients according to the AKIN, pRIFLE, and KDIGO systems, respectively. The KDIGO classification categorized 121 patients (8%) who were placed in the AKIN 0 category, whereas the pRIFLE system categorized 74 (5%) in KDIGO 0 and 200 (14%) in AKIN 0 stages as having an AKI. The overall mortality rate was 3.9%. The KDIGO stage III (odds ratio [OR], 18.8; 95% confidence interval [CI], 9.6 to 36.6, p < 0.001), the AKIN stage III (OR, 38.3; 95% CI, 20.6 to 70.9, p < 0.001), and pRIFLE failure group (OR, 13.6, 95% CI, 7 to 26.3; p < 0.001) were associated with increased mortality. The pRIFLE system was the most sensitive test in detecting AKI, and this was especially so in the infant age group and also in the early identification of AKI in low-risk patients. The AKIN system was more specific and detected mostly high-risk patients across all age groups. The KDIGO classification system fell between pRIFLE and AKIN in performance. All three had increasing severity of AKI associated with mortality.

Lex DJ ，Tóth R ，Cserép Z ，Alexander SI ，Breuer T ，Sápi E ，Szatmári A ，Székely E ，Gál J ，Székely A ... -  《-》

Post-operative acute kidney injury in patients with renal cell carcinoma is a potent risk factor for new-onset chronic kidney disease after radical nephrectomy.

Cho A ，Lee JE ，Kwon GY ，Huh W ，Lee HM ，Kim YG ，Kim DJ ，Oh HY ，Choi HY ... -  《-》

Risk factors for acute kidney injury after radical nephrectomy and inferior vena cava thrombectomy for renal cell carcinoma.

The objectives of the present study are to estimate the incidence of postoperative acute kidney injury (AKI) after radical nephrectomy with inferior vena cava (IVC) thrombectomy for renal cell carcinoma (RCC) based on the Acute Kidney Injury Network (AKIN) criteria, to investigate the risk factors for postoperative AKI, and to define the association between postoperative AKI and clinical outcome in patients undergoing such a surgery. We retrospectively analyzed 76 patients (22 women; mean age, 56.9 years; range, 29-83 years) with RCC and IVC thrombus who underwent radical nephrectomy and IVC thrombectomy at our institute between January 2003 and December 2011. Postoperative AKI was diagnosed after surgery based on the AKIN criteria. Logistic regression was used to model the association between preoperative factors and the risk of AKI after surgery. The relationship between postoperative AKI and clinical outcomes, including chronic kidney disease (CKD), mortality, and days in hospital, was investigated. Postoperative AKI was diagnosed in 41 patients (53.9%) based on the AKIN criteria (stage 1, n = 34; stage 2, n = 2; and stage 3, n = 5). Multivariate analysis demonstrated an independent association between postoperative AKI and male gender (odds ratio 4.79, 95% confidence interval: 1.13-20.39; P = .034), and IVC clamping time lasting more than 20 minutes (odds ratio 6.60, 95% confidence interval: 1.48-29.42; P = .013). Development of AKI was associated with an increased rate of postoperative CKD (43.9% vs 20.0%; P = .031) and prolonged hospitalization (17.7 vs 12.2 days; P = .047). Only one patient who had postoperative AKI required renal replacement therapy. There was no 30-day mortality during the study period and no difference in mortality between AKI and non-AKI patients (4.9% vs 5.7%; P = .859). The incidence of postoperative AKI in patients with RCC and IVC thrombus was considerable. Intraoperative management seems to influence the risk of AKI after surgery; particularly, the longer the IVC clamping time, the higher the risk of postoperative AKI. Postoperative AKI was associated with postoperative CKD (P = .031), prolonged hospitalization (P = .047), and increased long-term mortality (1 year after surgery).

Shin S ，Han Y ，Park H ，Chung YS ，Ahn H ，Kim CS ，Cho YP ，Kwon TW ... -  《-》