Impact of renal failure requiring postoperative dialysis on lung transplant outcomes: A national registry study in children.

BACKGROUND

Renal dysfunction is a common postoperative complication following cardiothoracic surgery, including heart and lung transplantation. Among adult lung transplant (LTx) recipients, acute kidney injury is associated with increased morbidity and mortality with those requiring renal replacement therapy having the worst outcome. The prevalence and risk factors for renal failure requiring post-transplant dialysis and its effect on outcomes among children after LTx are unknown, prompting this investigation.

METHODS

Children less than 18 years of age who underwent LTx between 2000 and 2023 with known post-LTx dialysis status were identified in the United Network for Organ Sharing Registry. Univariate analyses, multivariable Cox regression, logistic regression, and a Kaplan-Meier plot were performed for a comprehensive analysis.

RESULTS

A total of 975 children were identified: 65 requiring post-LTx dialysis. There were no significant differences in demographics between pediatric recipients requiring and not requiring dialysis after LTx. However, children requiring post-LTx dialysis had lower estimated glomerular filtration rate (eGFR) at the time of transplantation (108 vs 132, p = 0.002). Those who were an extracorporeal mechanical oxygenation bridge to LTx, had a previous LTx, or had abnormal eGFR at the time of transplant were at a higher risk for dialysis postoperatively. The cohort requiring post-transplant dialysis had worse 1-, 3-, and 5-year post-LTx survival. A multivariable Cox model demonstrated post-LTx dialysis was associated with a statistically significant increase in mortality (hazard ratios 2.46; 95% confidence interval 1.81, 3.35; p < 0.001).

CONCLUSIONS

Renal failure requiring dialysis in children after LTx is associated with significantly worse survival.