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Postreperfusion plasma endothelial activation markers are associated with acute kidney injury after lung transplantation
Author(s) -
Forker Caitlin M.,
Miano Todd A.,
Reilly John P.,
Oyster Michelle L.,
Porteous Mary K.,
Cantu Edward E.,
Ware Lorraine B.,
Diamond Joshua M.,
Christie Jason D.,
Shashaty Michael G. S.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15402
Subject(s) - medicine , acute kidney injury , creatinine , biomarker , kidney transplantation , kidney disease , gastroenterology , transplantation , endothelial activation , lung transplantation , endothelium , biochemistry , chemistry
Acute kidney injury ( AKI ) is common after lung transplantation, but molecular markers remain poorly studied. The endothelial activation markers soluble thrombomodulin ( sTM ), protein C, and plasminogen activator inhibitor‐1 ( PAI ‐1) are implicated in kidney microcirculatory injury in animal models of AKI . We tested the association of 6‐hour postreperfusion plasma levels of these markers with posttransplant AKI severity in patients enrolled in the Lung Transplant Outcomes Group prospective cohort study at the University of Pennsylvania during two eras: 2004‐06 (n = 61) and 2013‐15 (n = 67). We defined AKI stage through postoperative day 5 using Kidney Disease Improving Global Outcomes creatinine criteria. We used multivariable ordinal logistic regression to determine the association of each biomarker with AKI , adjusted for primary graft dysfunction and extracorporeal life support. AKI occurred in 57 (45%) patients across both eras: 28 (22%) stage 1, 29 (23%) stage 2‐3. Higher sTM and lower protein C plasma levels were associated with AKI stage in each era and remained so in multivariable models utilizing both eras ( sTM : OR 1.76 [95% CI 1.19‐2.60] per standard deviation, P = .005; protein C: OR 0.54 [1.19‐2.60], P = .003). We conclude that 6‐hour postreperfusion plasma sTM and protein C levels are associated with early postlung transplant AKI severity.