Early major adverse kidney events after lung transplantation: risk of chronic kidney disease and prognostic impact.

OBJECTIVE

Renal dysfunction, including acute kidney injury (AKI) and chronic kidney disease (CKD), is a major complication following lung transplantation (LT) and is associated with increased morbidity and mortality. This study aims to evaluate the clinical significance of AKI in relation to the development of post-LT CKD and poor prognosis.

METHODS

Among 133 patients who underwent LT, 116 were included in the analysis. AKI was defined according to the Kidney Disease Improving Global Outcomes criteria. AKI was classified into early AKI (E-AKI), occurring within a few hours to one week postoperatively, and late AKI (L-AKI), occurring between one week and one month after LT. The Major Adverse Kidney Event within 30 days following LT (MAKE30)-a composite outcome that includes all-cause mortality, new renal replacement therapy, or persistent renal dysfunction-was also used in this study. Univariate and multivariate analyses were conducted to identify factors associated with the development of CKD. Overall survival (OS) was analyzed using the Kaplan-Meier method.

RESULTS

The proportions of patients who developed E-AKI, L-AKI, MAKE30, and CKD were 73%, 31%, 15%, and 46%, respectively. Multivariate analysis identified older age and the occurrence of MAKE30 as independent predictors of post-LT CKD. Notably, all recipients aged 50 years or older who experienced either L-AKI or MAKE30 subsequently developed CKD. In addition, the incidence of MAKE30 was marginally correlated with reduced OS.

CONCLUSION

The occurrence of L-AKI and MAKE30 following LT is associated with the development of CKD and MAKE30 also has a negative impact on OS.