Acute kidney injury within 72 hours after lung transplantation: incidence and perioperative risk factors.

To define the incidence and perioperative risk factors of acute kidney injury (AKI) within 72 hours after lung transplantation and clarify the relationship between postoperative AKI and outcome in patients undergoing lung transplantation. A retrospective observational study. A tertiary care academic center. Fifty-four patients who underwent lung transplantation between January 2006 and March 2010. None. After excluding 4 patients who died or required additional surgery during the first 72 hours after transplantation, 50 patients were included in the final analysis. Data were extracted from medical charts and electronic health record information system. Risk, injury, failure, loss, endstage (RIFLE) renal disease creatinine criteria were used for the diagnosis of AKI. AKI developed in 27 patients (54%) within 72 hours after transplantation. The incidence of AKI after double-lung transplantation was 87% compared to 40% following single-lung transplantation. The percentage of patients with intraoperative hypoxemia (SpO2<90%) was significantly different between the groups (AKI, 59%; Non-AKI, 22%). Volume of hydroxyethyl starch was significantly higher in AKI patients (912±507 mL) than non-AKI patients (535±338 mL). Baseline estimated glomerular filtration rate (eGFR) was significantly higher in AKI patients (99±27 mL/min/1.73 m2) than non-AKI patients (77±20 mL/min/1.73 m2). AKI based on the RIFLE criteria following lung transplantation is common. Patients who developed AKI were more likely to have an episode of intraoperative hypoxemia and undergo a double-lung transplantation. Contrary to other published studies, patients with a higher preoperative eGFR were more likely to develop AKI in the authors' cohort.

Ishikawa S ，Griesdale DE ，Lohser J 《-》

Acute kidney injury after lung resection surgery: incidence and perioperative risk factors.

Ishikawa S ，Griesdale DE ，Lohser J 《-》

Risk factors of postoperative acute kidney injury in patients undergoing esophageal cancer surgery.

The purpose of this study was to identify perioperative risk factors for postoperative acute kidney injury (AKI) in patients undergoing esophageal cancer surgery. A retrospective analysis of the prospectively collected medical data. A tertiary care university hospital. All consecutive adult patients (n=595) who underwent elective esophageal surgery for cancer between January 2005 and April 2012. None. AKI was defined by the AKI Network criteria based on serum creatinine changes within the first 48 hours after esophageal cancer surgery. The relationship between perioperative variables and AKI was evaluated using multivariate logistic regression. Postoperative AKI developed in 210 (35.3%) patients. Risk factors for AKI were body mass index (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.01-1.14), preoperative serum albumin level (OR 0.52; 95% CI 0.33-0.84), use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (OR 1.35; 95% CI 1.05-1.75), colloid infusion during surgery (OR 1.11; 95% CI 1.06-1.18), and postoperative 2-day C-reactive protein (OR 1.05; 95% CI 1.01-1.09). Postoperative AKI was associated with prolonged length of hospital stay. Postoperative AKI is common in patients undergoing esophageal surgery for cancer. Closer evaluation and monitoring in patients with risk factors for AKI may be warranted.

Lee EH ，Kim HR ，Baek SH ，Kim KM ，Chin JH ，Choi DK ，Kim WJ ，Choi IC ... -  《-》

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 ... -  《-》

Perioperative risk factors for acute kidney injury after liver resection surgery: an historical cohort study.

Tomozawa A ，Ishikawa S ，Shiota N ，Cholvisudhi P ，Makita K ... -  《-》