Postoperative Fluid Accumulation is Associated With Underestimation of AKI 
Severity in Lung Transplant Recipients

Kuhnert, Stefan; Sommerlad, Janine; Gall, Henning; Weder, Max M.; Wolff, Matthias; Eberle, Sebastian; Sander, Michael; Reichert, Martin; Koch, Christian; Askevold, Ingolf; Hecker, Andreas; Padberg, Winfried; Ostermann, Marlies; Mehta, Ravindra; Ronco, Claudio; Birk, Horst-Walter; Seeger, Werner; Mayer, Konstantin; Hecker, Matthias; Husain-Syed, Faeq

doi:10.1111/ctr.15457

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Postoperative Fluid Accumulation is Associated With Underestimation of AKI Severity in Lung Transplant Recipients

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Seeger, Werner
Lung Development and Remodeling, Max Planck Institute for Heart and Lung Research, Max Planck Society;

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Citation

Kuhnert, S., Sommerlad, J., Gall, H., Weder, M. M., Wolff, M., Eberle, S., et al. (2024). Postoperative Fluid Accumulation is Associated With Underestimation of AKI Severity in Lung Transplant Recipients. CLINICAL TRANSPLANTATION, 38(9): e15457. doi:10.1111/ctr.15457.

Cite as: https://hdl.handle.net/21.11116/0000-0010-08A2-E

Abstract

Background: Post-lung transplantation (LTx) fluid accumulation can lead
to dilution of serum creatinine (SCr). We hypothesized that fluid
accumulation might impact the diagnosis, staging, and outcome of
posttransplant acute kidney injury (AKI). Methods: In this retrospective
study, we analyzed data from 131 adult LTx patients at a single German
lung center between 2005 and 2018. We assessed the occurrence of AKI
within 7 days posttransplant, both before and after SCr-adjustment for
fluid balance (FB), and investigated its impact on all-cause mortality.
Transient and persistent AKIs were defined as return to baseline kidney
function or continuation of AKI beyond 72 h of onset, respectively.
Results: AKI was diagnosed in 58.8% of patients according to crude SCr
values. When considering FB-adjusted SCr values, AKI severity was
underestimated in 20.6% of patients, that is, AKI was detected in an
additional 6.9% of patients and led to AKI upstaging in 23.4% of cases.
Patients initially underestimated but detected with AKI only after FB
adjustment had higher mortality compared to those who did not meet AKI
criteria (hazard ratio [HR] 2.98; 95% confidence interval [CI] 1.06,
8.36; p = 0.038). Persistent AKI was associated with higher mortality
than transient AKI, regardless of using crude or adjusted SCr values (p
p < 0.05). Persistent AKI emerged as an independent risk factor for
mortality (HR 2.35; 95% CI 1.29, 4.30; p = 0.005). Conclusion: Adjusting
for FB and evaluating renal recovery patterns post-AKI may enhance the
sensitivity of AKI detection. This approach could help identify patients
with poor prognosis and potentially improve outcomes in lung transplant
recipients. Trial Registration: ClinicalTrials.gov identifier:
NCT03039959, NCT03046277.