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Acute kidney injury after lung transplantation, incidence, risk factors, and effects : A Swedish nationwide study

Grins, Edgars LU orcid ; Wijk, Johanna ; Bjursten, Henrik LU ; Zeaiter, Maria ; Lindstedt, Sandra LU ; Dellgren, Göran ; Ederoth, Per LU and Lannemyr, Lukas (2025) In Acta Anaesthesiologica Scandinavica 69(4).
Abstract

Background: Acute kidney injury (AKI) is a serious complication after lung transplantation, but the reported incidence varies in the literature. No data on AKI have been published from the Swedish lung transplantation program. Methods: The aim of our study was to investigate the incidence, perioperative risk factors, and effects of early postoperative acute kidney injury (Kidney Disease Improving Global Outcomes [KDIGO] criteria) after lung transplantation. A retrospective, nationwide study of 568 lung-transplanted patients in Sweden between 2011 and 2020 was performed. Results: The incidence of AKI (any grade) was 42%. Renal replacement therapy was used in 5% of the patients. Preoperative factors independently associated with increased... (More)

Background: Acute kidney injury (AKI) is a serious complication after lung transplantation, but the reported incidence varies in the literature. No data on AKI have been published from the Swedish lung transplantation program. Methods: The aim of our study was to investigate the incidence, perioperative risk factors, and effects of early postoperative acute kidney injury (Kidney Disease Improving Global Outcomes [KDIGO] criteria) after lung transplantation. A retrospective, nationwide study of 568 lung-transplanted patients in Sweden between 2011 and 2020 was performed. Results: The incidence of AKI (any grade) was 42%. Renal replacement therapy was used in 5% of the patients. Preoperative factors independently associated with increased incidence of AKI were higher body mass index (odds ratio [OR]: 1.07, 95% CI: 1.02, 1.12) longer time on transplantation waiting list (OR: 1.05 [1.01, 1.09]), re-transplantation (OR: 2.24 [1.05, 4.80]) and moderate to severe tricuspid regurgitation (OR: 2.61 [1.36, 5.03]). Intraoperative factors independently associated with increased incidence of AKI were use of cardiopulmonary bypass (OR: 2.70 [1.57, 4.63]), increasing number of transfused red blood cell units, and use of immunosuppressive therapy other than routine (OR: 2,56 [1.47, 4.46]). A higher diuresis (OR: 0.70, 95% CI: 0.58–0.85) was associated with less incidence of acute kidney injury. Development of AKI was associated with increased time to extubation (median 30 h, IQR [9, 118] vs. 6 [3, 16]), length of stay in the intensive care unit (9 days [4, 25] vs. 3 [2, 5]) and increased rate of primary graft dysfunction (OR 2.33 [1.66, 3.29]) and 30-day mortality (OR: 10.8 [3.0, 69]). Conclusions: Acute kidney injury is common after lung transplantation and affects clinical outcomes negatively. Preoperative factors may be used for risk assessment. The use of cardiopulmonary bypass is a potentially modifiable intraoperative risk factor. Editorial Comment: Acute kidney injury is a common complication after lung transplantation that severely influences patient outcomes. This large study of more than 500 patients treated over a decade identified potentially modifiable factors associated with the development of acute kidney injury.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute kidney injury, cardio-pulmonary bypass, incidence, lung transplantation, perioperative risk factors
in
Acta Anaesthesiologica Scandinavica
volume
69
issue
4
article number
e70014
publisher
Blackwell Munksgaard
external identifiers
  • pmid:40066686
  • scopus:105000081096
ISSN
0001-5172
DOI
10.1111/aas.70014
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.
id
e0e59b2d-a80f-43c7-a4ac-435f2236b79e
date added to LUP
2025-06-05 09:56:10
date last changed
2025-07-03 12:51:16
@article{e0e59b2d-a80f-43c7-a4ac-435f2236b79e,
  abstract     = {{<p>Background: Acute kidney injury (AKI) is a serious complication after lung transplantation, but the reported incidence varies in the literature. No data on AKI have been published from the Swedish lung transplantation program. Methods: The aim of our study was to investigate the incidence, perioperative risk factors, and effects of early postoperative acute kidney injury (Kidney Disease Improving Global Outcomes [KDIGO] criteria) after lung transplantation. A retrospective, nationwide study of 568 lung-transplanted patients in Sweden between 2011 and 2020 was performed. Results: The incidence of AKI (any grade) was 42%. Renal replacement therapy was used in 5% of the patients. Preoperative factors independently associated with increased incidence of AKI were higher body mass index (odds ratio [OR]: 1.07, 95% CI: 1.02, 1.12) longer time on transplantation waiting list (OR: 1.05 [1.01, 1.09]), re-transplantation (OR: 2.24 [1.05, 4.80]) and moderate to severe tricuspid regurgitation (OR: 2.61 [1.36, 5.03]). Intraoperative factors independently associated with increased incidence of AKI were use of cardiopulmonary bypass (OR: 2.70 [1.57, 4.63]), increasing number of transfused red blood cell units, and use of immunosuppressive therapy other than routine (OR: 2,56 [1.47, 4.46]). A higher diuresis (OR: 0.70, 95% CI: 0.58–0.85) was associated with less incidence of acute kidney injury. Development of AKI was associated with increased time to extubation (median 30 h, IQR [9, 118] vs. 6 [3, 16]), length of stay in the intensive care unit (9 days [4, 25] vs. 3 [2, 5]) and increased rate of primary graft dysfunction (OR 2.33 [1.66, 3.29]) and 30-day mortality (OR: 10.8 [3.0, 69]). Conclusions: Acute kidney injury is common after lung transplantation and affects clinical outcomes negatively. Preoperative factors may be used for risk assessment. The use of cardiopulmonary bypass is a potentially modifiable intraoperative risk factor. Editorial Comment: Acute kidney injury is a common complication after lung transplantation that severely influences patient outcomes. This large study of more than 500 patients treated over a decade identified potentially modifiable factors associated with the development of acute kidney injury.</p>}},
  author       = {{Grins, Edgars and Wijk, Johanna and Bjursten, Henrik and Zeaiter, Maria and Lindstedt, Sandra and Dellgren, Göran and Ederoth, Per and Lannemyr, Lukas}},
  issn         = {{0001-5172}},
  keywords     = {{acute kidney injury; cardio-pulmonary bypass; incidence; lung transplantation; perioperative risk factors}},
  language     = {{eng}},
  number       = {{4}},
  publisher    = {{Blackwell Munksgaard}},
  series       = {{Acta Anaesthesiologica Scandinavica}},
  title        = {{Acute kidney injury after lung transplantation, incidence, risk factors, and effects : A Swedish nationwide study}},
  url          = {{http://dx.doi.org/10.1111/aas.70014}},
  doi          = {{10.1111/aas.70014}},
  volume       = {{69}},
  year         = {{2025}},
}