Acute Kidney Injury After Ex Vivo Lung Perfusion (EVLP)

• Published in: Transplantation proceedings 2014-12, Vol.46 (10), p.3598-3602
• Main Authors: Hauck, J, Osho, A, Castleberry, A, Hartwig, M, Reddy, L, Phillips-Bute, B, Swaminathan, M, Mathew, J, Stafford-Smith, M
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; Extracorporeal Circulation - methods; Female; Humans; Incidence; Lung Transplantation - methods; Male; Middle Aged; North Carolina - epidemiology; Organ Preservation - methods; Perfusion - adverse effects; Retrospective Studies; Risk Assessment; Surgery; Survival Rate - trends; Tissue and Organ Procurement - methods
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2014.06.068

Abstract Background Ex vivo lung perfusion (EVLP) identifies viability for marginal organs but complicates and lengthens lung transplantation surgery. Preliminary evidence supports equivalency for EVLP-assisted versus traditional (non-EVLP) procedures regarding graft function, postoperative course, mortality, and survival. However, acute kidney injury (AKI), a common serious complication of lung transplantation, has not been assessed. We tested the hypothesis that EVLP-assisted and non-EVLP lung transplantations are associated with different AKI rates. Methods Demographic, procedural, and renal data were gathered for 13 EVLP-viable lung transplantations and a non-EVLP group matched 4:1 for single versus double, pulmonary disease, and age. AKI was defined by AKI Network (AKIN) criteria and peak creatinine rise relative to baseline (Δ%Cr) during the 1st 10 postoperative days. Chi-square was performed for AKIN and 2-tailed t test for %ΔCr. Results Patient and procedural characteristics were similar between the groups. One non-EVLP patient required postoperative dialysis. AKI rates were also similar, as assessed by both AKIN (EVLP 7/13 (54%) vs non-EVLP 32/52 (62%); P  = .61) and %ΔCr (EVLP 91 ± 81% vs non-EVLP 72 ± 62%; P  = .63). Conclusions We did not observe different AKI rates between EVLP-assisted and traditional lung transplant procedures. Although 1 non-EVLP patient required dialysis, AKI rates were otherwise similar. These findings further support EVLP as a strategy to expand the organ pool and reduce concerns for high–renal risk recipients. The small sample size and retrospective design are limitations. However, our sample size is similar to other reports, and it is the first to analyze AKI after EVLP-assisted lung transplantation. Larger multicenter prospective studies are needed.