The Need for Haemofiltration after Lung Transplantation is a Marker of Poor Early Outcomes, but Has No Deleterious Long-Term Renal Effect - A UK Cohort Study

Abstract

Purpose Haemofiltration dependent acute kidney injury (AKI) is associated with worse early survival after lung transplantation, but its long-term renal consequences are not known. This study aimed to examine its impact on the mortality and long-term renal function in the adult lung recipients in the UK. Methods Characteristics including age, gender, pre-op lung pathology, and diabetes mellitus (DM), survival status, peri-op renal function and post-op haemofiltration of all adult patients, who received lung transplantation between 1995 and 2017 in the UK, were retrieved from the UK Transplant Registry. Serum creatinine was collected immediately pre-op, 3-month post-op, and annually afterwards, and eGFR was calculated using the abbreviated MDRD equation. Multivariable Cox regression was used to study the risk factors associated with mortality and development of stage 4 or 5 chronic kidney disease (eGRF Results A total of 2929 adult patients underwent lung transplantation in the UK from 1995 to 2017. 488 (16.7%) of them developed post-op haemofiltration dependent AKI. Their 1-year survival, 47.1% (95% CI: 42.8-51.8%), and 5-year survival, 30.8% (95% CI: 26.6-35.7%) were significantly worse than that of the non-haemofiltration group, 85.1% (95% CI: 83.6-86.5%), and 58.2% (95% CI: 56.1-60.4%), respectively. Age (p = 0.019, HR 1.01) and post-op haemofiltration (p Conclusion This study confirmed that post-transplant haemofiltration dependent AKI is associated with increased mortality, especially within the first year. However, in contrast with studies in the non-transplant patients, it does not accelerate the deterioration of recipients’ renal function in the long term. It was speculated that in this cohort, closely screened for renal dysfunction, early AKI is associated with primary graft dysfunction. Hence, haemofiltration was started at an earlier stage than would be dictated by renal status alone. The total burden of purely renal injury might therefore be over-estimated.