Acute Kidney Injury after Lung Transplantation: A Systematic Review and Meta-Analysis

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background: Lung transplantation has been increasingly performed worldwide and is considered an effective therapy for patients with various causes of end-stage lung diseases. We performed a systematic review to assess the incidence and impact of acute kidney injury (AKI) and severe AKI requiring renal replacement therapy (RRT) in patients after lung transplantation. Methods: A literature search was conducted utilizing Ovid MEDLINE, EMBASE, and Cochrane Database from inception through June 2019. We included studies that evaluated the incidence of AKI, severe AKI requiring RRT, and mortality risk of AKI among patients after lung transplantation. Pooled incidence and odds ratios (ORs) with 95% confidence interval (CI) were obtained using random-effects meta-analysis. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42019134095). Results: A total of 26 cohort studies with a total of 40,592 patients after lung transplantation were enrolled. Overall, the pooled estimated incidence rates of AKI (by standard AKI definitions) and severe AKI requiring RRT following lung transplantation were 52.5% (95% CI: 45.8–59.1%) and 9.3% (95% CI: 7.6–11.4%). Meta-regression analysis demonstrated that the year of study did not significantly affect the incidence of AKI ( p = 0.22) and severe AKI requiring RRT ( p = 0.68). The pooled ORs of in-hospital mortality in patients after lung transplantation with AKI and severe AKI requiring RRT were 2.75 (95% CI, 1.18–6.41) and 10.89 (95% CI, 5.03–23.58). At five years, the pooled ORs of mortality among patients after lung transplantation with AKI and severe AKI requiring RRT were 1.47 (95% CI, 1.11–1.94) and 4.79 (95% CI, 3.58–6.40), respectively. Conclusion: The overall estimated incidence rates of AKI and severe AKI requiring RRT in patients after lung transplantation are 52.5% and 9.3%, respectively. Despite advances in therapy, the incidence of AKI in patients after lung transplantation does not seem to have decreased. In addition, AKI after lung transplantation is significantly associated with reduced short-term and long-term survival.

Related collections

Most cited references 60

Record: found
Abstract: found
Article: not found

An assessment of the RIFLE criteria for acute renal failure in hospitalized patients.

Shigehiko Uchino, Rinaldo Bellomo, Donna Goldsmith … (2006)

The Acute Dialysis Quality Initiative (ADQI) Group published a consensus definition (the RIFLE criteria) for acute renal failure. We sought to assess the ability of the RIFLE criteria to predict mortality in hospital patients. Retrospective single-center study. University-affiliated hospital. All patients admitted to the study hospital between January 2000 and December 2002. Patients were excluded if they were younger than 15 yrs old, were on chronic dialysis, or had kidney transplant or if their length of hospital stay was <24 hrs. None. We included 20,126 patients. Mean age was 64 yrs, 14.7% of patients required intensive care unit admission, and hospital mortality was 8.0%. According to the RIFLE criteria, 9.1% of all patients were in the Risk category for acute renal failure, 5.2% were in the Injury category, and 3.7% were in the Failure category. There was an almost linear increase in hospital mortality from Normal to Failure (Normal, 4.4%; Risk, 15.1%; Injury, 29.2%; and Failure, 41.1%). Multivariate logistic regression analysis showed that all RIFLE criteria were significantly predictive factors for hospital mortality, with an almost linear increase in odds ratios from Risk to Failure (odds ratios, Risk 2.5, Injury 5.4, Failure 10.1). The RIFLE criteria for acute renal failure classified close to 20% of our study patients as having some degrees of acute impairment in renal function and were useful in predicting their hospital mortality.

0 comments Cited 208 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Acute kidney injury associates with increased long-term mortality.

Jean-Philippe Lafrance, Donald Miller (2010)

Acute kidney injury (AKI) associates with higher in-hospital mortality, but whether it also associates with increased long-term mortality is unknown, particularly after accounting for residual kidney function after hospital discharge. We retrospectively analyzed data from US veteran patients who survived at least 90 d after discharge from a hospitalization. We identified AKI events not requiring dialysis from laboratory data and classified them according to the ratio of the highest creatinine during the hospitalization to the lowest creatinine measured between 90 d before hospitalization and the date of discharge. We estimated mortality risks using multivariable Cox regression models adjusting for demographics, comorbidities, medication use, primary diagnosis of admission, length of stay, mechanical ventilation, and postdischarge estimated GFR (residual kidney function). Among the 864,933 hospitalized patients in the study cohort, we identified 82,711 hospitalizations of patients with AKI. In the study population of patients who survived at least 90 d after discharge, 17.4% died during follow-up (AKI 29.8%, without AKI 16.1%). The adjusted mortality risk associated with AKI was 1.41 (95% confidence interval [CI] 1.39 to 1.43) and increased with increasing AKI stage: 1.36 (95% CI 1.34 to 1.38), 1.46 (95% CI 1.42 to 1.50), and 1.59 (95% CI 1.54 to 1.65; P < 0.001 for trend). In conclusion, AKI that does not require dialysis associates with increased long-term mortality risk, independent of residual kidney function, for patients who survive 90 d after discharge. Long-term mortality risk is highest among the most severe cases of AKI.

0 comments Cited 184 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Injurious mechanical ventilation and end-organ epithelial cell apoptosis and organ dysfunction in an experimental model of acute respiratory distress syndrome.

Yumiko Imai, Jean Parodo, Osamu Kajikawa … (2015)

Recent clinical trials have demonstrated a decrease in multiple organ dysfunction syndrome (MODS) and mortality in patients with acute respiratory distress syndrome (ARDS) treated with a protective ventilatory strategy. To examine the hypothesis that an injurious ventilatory strategy may lead to end-organ epithelial cell apoptosis and organ dysfunction. In vivo animals: 24 rabbits with acid-aspiration lung injury were ventilated with injurious or noninjurious ventilatory strategies. In vitro: rabbit epithelial cells were exposed to plasma from in vivo rabbit studies. In vivo human: plasma samples from patients included in a previous randomized controlled trial examining a lung protective strategy were analyzed (lung protection group, n = 9 and controls, n = 11). In vivo animals: biochemical markers of liver and renal dysfunction; apoptosis in end organs. In vitro: induction of apoptosis in LLC-RK1 renal tubular epithelial cells. In vivo human: correlation of plasma creatinine and soluble Fas ligand. The injurious ventilatory strategy led to increased rates of epithelial cell apoptosis in the kidney (mean [SE]: injurious, 10.9% [0.88%]; noninjurious, 1.86% [0.17%]; P<.001) and small intestine villi (injurious, 6.7% [0.66%]; noninjurious, 0.97% [0.14%]; P<.001), and led to the elevation of biochemical markers indicating renal dysfunction in vivo. Induction of apoptosis was increased in LLC-RK1 cells incubated with plasma from rabbits ventilated with injurious ventilatory strategy at 4 hours (P =.03) and 8 hours (P =.002). The Fas:Ig, a fusion protein that blocks soluble Fas ligand, attenuated induction of apoptosis in vitro. There was a significant correlation between changes in soluble Fas ligand and changes in creatinine in patients with ARDS (R = 0.64, P =.002). Mechanical ventilation can lead to epithelial cell apoptosis in the kidney and small intestine, accompanied by biochemical evidence of organ dysfunction. This may partially explain the high rate of MODS observed in patients with ARDS and the decrease in morbidity and mortality in patients treated with a lung protective strategy.

0 comments Cited 147 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): J Clin Med

Journal ID (iso-abbrev): J Clin Med

Journal ID (publisher-id): jcm

Title: Journal of Clinical Medicine

Publisher: MDPI

ISSN (Electronic): 2077-0383

Publication date (Electronic): 17 October 2019

Publication date Collection: October 2019

Volume: 8

Issue: 10

Electronic Location Identifier: 1713

Affiliations

[1 ]Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY 13326, USA; ploypinlert@ 123456gmail.com (P.L.); kanramon@ 123456gmail.com (K.W.)

[2 ]Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA; charat.thongprayoon@ 123456gmail.com

[3 ]Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA; sohail3553@ 123456gmail.com

[4 ]Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA 19140, USA; 109426469@ 123456umail.ucc.ie

[5 ]Department of Internal Medicine, St. Agnes Hospital, Baltimore, MD 21229, USA; nsrivali@ 123456gmail.com

[6 ]Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA; tarunjacobb@ 123456gmail.com

[7 ]Department of Medicine, Deaconess Health System, Evansville, IN 47747, USA; dr.anreddy@ 123456gmail.com

[8 ]Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH 44195, USA; p.ungprasert@ 123456gmail.com

[9 ]Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA; erin.a.gillaspie@ 123456vumc.org

[10 ]Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; dr.karn.wi@ 123456gmail.com (K.W.); mao.michael@ 123456mayo.edu (M.A.M.)

[11 ]Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand

Author notes

[* ]Correspondence: wcheungpasitporn@ 123456gmail.com (W.C.); wisitnephro@ 123456gmail.com (W.K.); Tel.: +1-601-984-5670 (W.C. & W.K.)

Author information

Wisit Cheungpasitporn https://orcid.org/0000-0001-9954-9711

Narothama Reddy Aeddula https://orcid.org/0000-0001-8530-668X

Patompong Ungprasert https://orcid.org/0000-0002-4817-9404

Michael A. Mao https://orcid.org/0000-0003-1814-7003

Wisit Kaewput https://orcid.org/0000-0003-2920-7235

Article

Publisher ID: jcm-08-01713

DOI: 10.3390/jcm8101713

PMC ID: 6833042

PubMed ID: 31627379

SO-VID: d75acd28-ec1b-4c27-ac6d-eb32df0ecc5a

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Acute Kidney Injury after Lung Transplantation: A Systematic Review and Meta-Analysis

Read this article at

Abstract

Related collections

Karger: Nephrology

Most cited references 60

An assessment of the RIFLE criteria for acute renal failure in hospitalized patients.

Acute kidney injury associates with increased long-term mortality.

Injurious mechanical ventilation and end-organ epithelial cell apoptosis and organ dysfunction in an experimental model of acute respiratory distress syndrome.

Author and article information

Journal

Affiliations

Author notes

Author information

Article

History

Categories

Comments

Comment on this article

Similar content 347

Cited by 21

Most referenced authors 2,189