(637) - Microarray Analysis of Transbronchial Biopsies in Lung Transplant Recipients Detects Molecular Changes of T-cell Mediated Inflammation

Abstract

s S235 Methods: An analysis of all LTR at a single center from 10/2011-12/2013 was conducted; re-transplant and multi-organ recipients were excluded. RIFLE criteria was applied and AKI within 72 hours post-operatively was categorized as Risk (SCr 1.5x baseline), Injury (SCr 2x baseline), Failure (SCr 3x baseline), Loss (renal replacement therapy [RRT] > 4 weeks), and End-Stage disease (RRT > 3 months). Outcomes were assessed at 1 year and risk factors were compared between LTR with and without AKI. Results: Sixty-two LTR were included; the cohort was largely white males with IPF (45%) or COPD (35%). A total of 26 patients met the criteria for AKI: 17 (30.6%) Risk, 7 (11.3%) Injury, 2 (3.2%) Failure. Two patients who met AKI criteria for Failure progressed to end-stage disease. Mortality at 1 year (15% vs. 0%, p= 0.015) was significantly higher in LTRs with early AKI (Figure 1); ICU and hospital LOS were also prolonged (Table 1). Patients who had higher LAS and bilateral lungs were more likely to develop AKI. Peri-operative factors increasing ischemic injury including use of CPB, decreased intra-op SpO2, and duration of vasopressors were all significantly associated with AKI. Comorbidities and patient demographics did not appear to influence development of early AKI. Tacrolimus initiation was delayed in the AKI cohort as expected, and while not statistically significant, there was an increased cumulative dose of diuretics in the AKI cohort. Conclusion: Early AKI was shown to have worse 1 year mortality rates and longer hospital/ICU LOS. Ischemic risk factors in the peri-operative period was associated with development of AKI in LTR.