Analysis of risk factors of acute kidney injury in perioperative patients after lung transplantation

Background: This study sought to examine the factors influencing acute kidney injury (AKI) in the perioperative period after lung transplantation (LT). Methods: We collected and analyzed the clinical data of 25 patients, who were diagnosed with AKI in the perioperative period after LT at Sichuan Provincial People's Hospital from July 1, 2018 to June 30, 2020. Based on the clinical outcomes, the patients were divided into an AKI group and a non-AKI group. Differences between the two groups were compared, including differences in mechanical ventilation (MV) time and intensive care unit (ICU) stay time, the mode of transplantation, the total amount of dehydration in the first week after surgery, use of potential kidney damaging drugs, and whether extracorporeal membrane oxygenation (ECMO) was used. Results: Nineteen patients (76%) were diagnosed with AKI in the perioperative period after LT. There were no statistically significant differences between the two groups in terms of basic information, the mode of transplantation, the total amount of dehydration in the first week after surgery, the daily dose of tacrolimus, whether ganciclovir was used, whether voriconazole was used, whether ECMO was used, and mortality (P>0.05). However, the MV time and ICU stay time of the AKI group was longer than that of the non-AKI group (P=0.006, 0.011, respectively). Analysis within the group shows there were no significant differences in terms of mortality, the MV time, and the ICU stay time between the AKI stage two group and the AKI stage three group (all P>0.05). A multi-factor analysis was conducted in which AKI was the dependent variable, whether an amount of dehydration greater than 2,000 mL, a body mass index (BMI) greater than 18, and the use of ganciclovir and voriconazole had been examined as an independent variable; however, none of these were found to be risk factors associated with AKI. Conclusions: The incidence of AKI in the perioperative period after LT is high. AKI in the perioperative period after LT prolonged patients' MV time and ICU stay time. In the perioperative management of LT, it is necessary to consider kidney protection to reduce the risk of AKI.