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The association of post–lung transplant acute kidney injury with mortality is independent of primary graft dysfunction: A cohort study
Author(s) -
Shashaty Michael G. S.,
Forker Caitlin M.,
Miano Todd A.,
Wu Qufei,
Yang Wei,
Oyster Michelle L.,
Porteous Mary K.,
Cantu Edward E.,
Diamond Joshua M.,
Christie Jason D.
Publication year - 2019
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13678
Subject(s) - medicine , cohort , lung , cohort study , lung transplantation , acute kidney injury , intensive care medicine , surgery
Background Prior studies of post–lung transplant acute kidney injury (AKI) have not accounted for confounding effects of primary graft dysfunction (PGD). We sought to test the impact of PGD on AKI risk factors and on the association of AKI with mortality. Methods We included patients transplanted at the University of Pennsylvania from 2005‐12, defined AKI using consensus criteria during transplant hospitalization, and defined PGD as grade 3 at 48‐72 hours. We used multivariable logistic regression to test the impact of PGD on AKI risk factors and Cox models to test association of AKI with one‐year mortality adjusting for PGD and other confounders. Results Of 299 patients, 188 (62.9%) developed AKI with 142 (75%) cases occurring by postoperative day 4. In multivariable models, PGD was strongly associated with AKI (OR 3.76, 95% CI 1.72‐8.19, P = .001) but minimally changed associations of other risk factors with AKI. Both AKI (HR 3.64, 95% CI 1.68‐7.88, P = .001) and PGD (HR 2.55, 95% CI 1.40‐4.64, P = .002) were independently associated with one‐year mortality. Conclusions Post–lung transplant AKI risk factors and association of AKI with mortality were independent of PGD. AKI may therefore be a target for improving lung transplant mortality rather than simply an epiphenomenon of PGD.