ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Characteristics of Bilateral Orthotopic Lung Transplant Patients that Develop Severe Perioperative Acute Kidney Injury
Session Title
TP23 - TP023 LUNG TRANSPLANT: OUTCOME PREDICTORS AND THERAPEUTIC OPTIONS
Abstract
A1782 - Characteristics of Bilateral Orthotopic Lung Transplant Patients that Develop Severe Perioperative Acute Kidney Injury
Author Block: B. A. Bottiger1, K. Subramaniam2, F. Ius3, G. Warnecke4, M. Hartwig5, G. Loor6, D. Daoud6, Q. Wei7, M. Villavicencio-Theoduloz8, A. Osho8, D. Van Raemdonck9, S. Chandrashekaran10, T. Machuca11, Y. Toyoda12, M. Kashem13, S. Huddleston14, M. Landeweer15, P. Sanchez16, N. Ryssel17, A. Neyrinck18; 1Anesthesiology, Duke University, Durham, NC, United States, 2Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, United States, 3Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany, 4Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Heidelberg University, Heidelberg, Germany, 5Department of Cardiothoracic Surgery, Duke University, Durham, NC, United States, 6Michael E. Debakey Department of Surgery, Division of cardiothoracic transplantation and mechanical, Baylor College of Medicine, Houston, TX, United States, 7Michael E. Debakey Department of Surgery, Division of cardiothoracic transplantation and mechanical, Baylor College of Medicine, Houston, NC, United States, 8Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, United States, 9Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium, 10Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, United States, 11Division of thoracic and cardiovascular surgery, Temple University, Philadelphia, PA, United States, 12Surgery, Temple Univ Sch of Medicine, Philadelphia, PA, United States, 13Division of Cardiothoracic Surgery, Temple University, Philadelphia, PA, United States, 14Division of Cardiothoracic Surgery, University of Minnesota Medical School, Minneapolis, MN, United States, 15Department of Surgery, University of Minnesota, Minneapolis, MN, United States, 16Division of Cardiothoracic Surgeons, University of Pittsburgh Medical Center, Pittsburgh, PA, United States, 17Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, NC, United States, 18Anesthesiology, University Hospitals Leuven, Leuven, Belgium.
Rationale. Perioperative acute kidney injury (AKI) after bilateral orthotopic lung transplantation (BOLT) is associated with significant morbidity. In this international, multicenter study of patients undergoing primary BOLT, we describe the perioperative characteristics and outcomes of recipients who develop severe AKI. Methods. The Extracorporeal Life Support (ECLS) in lung transplantation registry includes data on BOLT patients from 9 high volume (>40 transplants/yr) transplant centers (2 from Europe, 7 from United States). Adult BOLT recipients from Jan 2016 to Nov 2020 with complete 48-hour creatinine (Cr) values were included. We excluded patients with primary pulmonary hypertension, mean PAP≥40mmHg, dialysis history, underwent multi-organ or redo transplantation, or concomitant cardiac surgery. Patients were grouped by whether they developed severe AKI, defined as increased Cr >2x baseline (>Gr2 by RIFLE criteria) or dialysis use. Secondary outcomes included primary graft dysfunction (PGD) at 24, 48, and 72 hours, postoperative ECMO use, reintubation, tracheostomy, intraoperative urine output (UOP), length of stay (LOS), and death at 90 days and 1 year. Donor, recipient, and operative characteristics were compared between groups. Multiple logistic regression analyses were performed after adjustment for several covariates. Results. Five hundred eighty-nine BOLT patients were included. Of those, 509 did not develop severe AKI (no severe AKI group), while 80 (13.6%) were in the severe AKI group. Dialysis during the index hospitalization was required in 46% (N=37) of recipients who developed severe AKI. Comparisons between groups are displayed in Table 1a. Recipients with severe AKI had higher LAS, higher mean PA pressures, right ventricular dysfunction, and less likely to have a donor who smoked. Severe AKI patients had longer ischemic times, reduced intraoperative UOP, intraoperative ECLS and received more red blood cell transfusions. Worsened secondary outcomes were observed in the severe AKI group. Table 1b describes the association of severe AKI to secondary outcomes. For every unit increase in ΔCr relayed an estimated 12 day increase in LOS (12.24 d±2.35, p=0.001). Adjusted multivariate analysis showed higher risk of mortality in the severe AKI group at 90 days (OR 0.07, 0.02-0.26, p< 0.0001) and 1 year (OR 0.12, 0.05-0.26, p=<0.0001). Conclusion. In this multicenter international registry, 13.6% of select, low risk lung transplant patients developed severe AKI, with 46% of the severe AKI cohort requiring dialysis during the index hospitalization. Recipients with perioperative severe AKI have associated worsened PGD, 161% longer LOS, and increased mortality.
Author Block: B. A. Bottiger1, K. Subramaniam2, F. Ius3, G. Warnecke4, M. Hartwig5, G. Loor6, D. Daoud6, Q. Wei7, M. Villavicencio-Theoduloz8, A. Osho8, D. Van Raemdonck9, S. Chandrashekaran10, T. Machuca11, Y. Toyoda12, M. Kashem13, S. Huddleston14, M. Landeweer15, P. Sanchez16, N. Ryssel17, A. Neyrinck18; 1Anesthesiology, Duke University, Durham, NC, United States, 2Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, United States, 3Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany, 4Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Heidelberg University, Heidelberg, Germany, 5Department of Cardiothoracic Surgery, Duke University, Durham, NC, United States, 6Michael E. Debakey Department of Surgery, Division of cardiothoracic transplantation and mechanical, Baylor College of Medicine, Houston, TX, United States, 7Michael E. Debakey Department of Surgery, Division of cardiothoracic transplantation and mechanical, Baylor College of Medicine, Houston, NC, United States, 8Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, United States, 9Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium, 10Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, United States, 11Division of thoracic and cardiovascular surgery, Temple University, Philadelphia, PA, United States, 12Surgery, Temple Univ Sch of Medicine, Philadelphia, PA, United States, 13Division of Cardiothoracic Surgery, Temple University, Philadelphia, PA, United States, 14Division of Cardiothoracic Surgery, University of Minnesota Medical School, Minneapolis, MN, United States, 15Department of Surgery, University of Minnesota, Minneapolis, MN, United States, 16Division of Cardiothoracic Surgeons, University of Pittsburgh Medical Center, Pittsburgh, PA, United States, 17Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, NC, United States, 18Anesthesiology, University Hospitals Leuven, Leuven, Belgium.
Rationale. Perioperative acute kidney injury (AKI) after bilateral orthotopic lung transplantation (BOLT) is associated with significant morbidity. In this international, multicenter study of patients undergoing primary BOLT, we describe the perioperative characteristics and outcomes of recipients who develop severe AKI. Methods. The Extracorporeal Life Support (ECLS) in lung transplantation registry includes data on BOLT patients from 9 high volume (>40 transplants/yr) transplant centers (2 from Europe, 7 from United States). Adult BOLT recipients from Jan 2016 to Nov 2020 with complete 48-hour creatinine (Cr) values were included. We excluded patients with primary pulmonary hypertension, mean PAP≥40mmHg, dialysis history, underwent multi-organ or redo transplantation, or concomitant cardiac surgery. Patients were grouped by whether they developed severe AKI, defined as increased Cr >2x baseline (>Gr2 by RIFLE criteria) or dialysis use. Secondary outcomes included primary graft dysfunction (PGD) at 24, 48, and 72 hours, postoperative ECMO use, reintubation, tracheostomy, intraoperative urine output (UOP), length of stay (LOS), and death at 90 days and 1 year. Donor, recipient, and operative characteristics were compared between groups. Multiple logistic regression analyses were performed after adjustment for several covariates. Results. Five hundred eighty-nine BOLT patients were included. Of those, 509 did not develop severe AKI (no severe AKI group), while 80 (13.6%) were in the severe AKI group. Dialysis during the index hospitalization was required in 46% (N=37) of recipients who developed severe AKI. Comparisons between groups are displayed in Table 1a. Recipients with severe AKI had higher LAS, higher mean PA pressures, right ventricular dysfunction, and less likely to have a donor who smoked. Severe AKI patients had longer ischemic times, reduced intraoperative UOP, intraoperative ECLS and received more red blood cell transfusions. Worsened secondary outcomes were observed in the severe AKI group. Table 1b describes the association of severe AKI to secondary outcomes. For every unit increase in ΔCr relayed an estimated 12 day increase in LOS (12.24 d±2.35, p=0.001). Adjusted multivariate analysis showed higher risk of mortality in the severe AKI group at 90 days (OR 0.07, 0.02-0.26, p< 0.0001) and 1 year (OR 0.12, 0.05-0.26, p=<0.0001). Conclusion. In this multicenter international registry, 13.6% of select, low risk lung transplant patients developed severe AKI, with 46% of the severe AKI cohort requiring dialysis during the index hospitalization. Recipients with perioperative severe AKI have associated worsened PGD, 161% longer LOS, and increased mortality.
