Characteristics and outcomes among patients with need for early dialysis after lung transplantation surgery

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Abstract

Background: With the introduction of lung allocation score (LAS), increasingly sicker patients are undergoing lung transplantation (LT). This study was conducted to determine the time trends in need for dialysis after LT, identify variables independently associated with need for dialysis, and evaluate its association with 1- and 5-year mortality. Methods: We queried the United Network of Organ Sharing database for adult patients undergoing LT between 1994 and 2014. We excluded patients with simultaneous dual organ transplantation and where data regarding the need for dialysis were not available. Results: Time trends in the yearly incidence of the need for dialysis showed a gradual increase (P =.012). In the post-LAS era, ethnicity, underlying diagnosis, estimated GFR <90 mL/min/1.73 m2 and mean pulmonary pressures>35 mm Hg, ventilator or extracorporeal membrane oxygenation support at LT, and >20% increase in serum creatinine between listing and match were independently associated with the need for dialysis. Patients with need for dialysis had significantly increased hazard of 1-year (n = 13 849; adjusted hazard ratio, 95% CI:7.23, 6.2-8.4, P <.001) and 5-year mortality (n = 7287; adjusted hazard ratio, 95% CI:3.96, 3.43-4.56, P <.001). Conclusions: There is a gradual increase in the incidence of the need for early dialysis after LT, and these patients have significantly worse early and late survival. Several pre-transplant recipient characteristics are independently associated with the need for dialysis.

Original languageEnglish (US)
Article numbere13106
JournalClinical Transplantation
Volume31
Issue number11
DOIs
StatePublished - Nov 1 2017

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Lung Transplantation
Dialysis
Lung
Extracorporeal Membrane Oxygenation
Mortality
Incidence
Organ Transplantation
Mechanical Ventilators
Creatinine
Databases
Survival
Serum

Keywords

  • 1-year survival
  • 5-year survival
  • chronic kidney disease
  • lung allocation score
  • recipient characteristics

ASJC Scopus subject areas

  • Transplantation

Cite this

@article{c41c15ea4752449ea83b2d74df5008e9,
title = "Characteristics and outcomes among patients with need for early dialysis after lung transplantation surgery",
abstract = "Background: With the introduction of lung allocation score (LAS), increasingly sicker patients are undergoing lung transplantation (LT). This study was conducted to determine the time trends in need for dialysis after LT, identify variables independently associated with need for dialysis, and evaluate its association with 1- and 5-year mortality. Methods: We queried the United Network of Organ Sharing database for adult patients undergoing LT between 1994 and 2014. We excluded patients with simultaneous dual organ transplantation and where data regarding the need for dialysis were not available. Results: Time trends in the yearly incidence of the need for dialysis showed a gradual increase (P =.012). In the post-LAS era, ethnicity, underlying diagnosis, estimated GFR <90 mL/min/1.73 m2 and mean pulmonary pressures>35 mm Hg, ventilator or extracorporeal membrane oxygenation support at LT, and >20{\%} increase in serum creatinine between listing and match were independently associated with the need for dialysis. Patients with need for dialysis had significantly increased hazard of 1-year (n = 13 849; adjusted hazard ratio, 95{\%} CI:7.23, 6.2-8.4, P <.001) and 5-year mortality (n = 7287; adjusted hazard ratio, 95{\%} CI:3.96, 3.43-4.56, P <.001). Conclusions: There is a gradual increase in the incidence of the need for early dialysis after LT, and these patients have significantly worse early and late survival. Several pre-transplant recipient characteristics are independently associated with the need for dialysis.",
keywords = "1-year survival, 5-year survival, chronic kidney disease, lung allocation score, recipient characteristics",
author = "Amit Banga and Manish Mohanka and Jessica Mullins and Srinivas Bollineni and Vaidehi Kaza and Bekir Tanriover and Fernando Torres",
year = "2017",
month = "11",
day = "1",
doi = "10.1111/ctr.13106",
language = "English (US)",
volume = "31",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",
number = "11",

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TY - JOUR

T1 - Characteristics and outcomes among patients with need for early dialysis after lung transplantation surgery

AU - Banga, Amit

AU - Mohanka, Manish

AU - Mullins, Jessica

AU - Bollineni, Srinivas

AU - Kaza, Vaidehi

AU - Tanriover, Bekir

AU - Torres, Fernando

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Background: With the introduction of lung allocation score (LAS), increasingly sicker patients are undergoing lung transplantation (LT). This study was conducted to determine the time trends in need for dialysis after LT, identify variables independently associated with need for dialysis, and evaluate its association with 1- and 5-year mortality. Methods: We queried the United Network of Organ Sharing database for adult patients undergoing LT between 1994 and 2014. We excluded patients with simultaneous dual organ transplantation and where data regarding the need for dialysis were not available. Results: Time trends in the yearly incidence of the need for dialysis showed a gradual increase (P =.012). In the post-LAS era, ethnicity, underlying diagnosis, estimated GFR <90 mL/min/1.73 m2 and mean pulmonary pressures>35 mm Hg, ventilator or extracorporeal membrane oxygenation support at LT, and >20% increase in serum creatinine between listing and match were independently associated with the need for dialysis. Patients with need for dialysis had significantly increased hazard of 1-year (n = 13 849; adjusted hazard ratio, 95% CI:7.23, 6.2-8.4, P <.001) and 5-year mortality (n = 7287; adjusted hazard ratio, 95% CI:3.96, 3.43-4.56, P <.001). Conclusions: There is a gradual increase in the incidence of the need for early dialysis after LT, and these patients have significantly worse early and late survival. Several pre-transplant recipient characteristics are independently associated with the need for dialysis.

AB - Background: With the introduction of lung allocation score (LAS), increasingly sicker patients are undergoing lung transplantation (LT). This study was conducted to determine the time trends in need for dialysis after LT, identify variables independently associated with need for dialysis, and evaluate its association with 1- and 5-year mortality. Methods: We queried the United Network of Organ Sharing database for adult patients undergoing LT between 1994 and 2014. We excluded patients with simultaneous dual organ transplantation and where data regarding the need for dialysis were not available. Results: Time trends in the yearly incidence of the need for dialysis showed a gradual increase (P =.012). In the post-LAS era, ethnicity, underlying diagnosis, estimated GFR <90 mL/min/1.73 m2 and mean pulmonary pressures>35 mm Hg, ventilator or extracorporeal membrane oxygenation support at LT, and >20% increase in serum creatinine between listing and match were independently associated with the need for dialysis. Patients with need for dialysis had significantly increased hazard of 1-year (n = 13 849; adjusted hazard ratio, 95% CI:7.23, 6.2-8.4, P <.001) and 5-year mortality (n = 7287; adjusted hazard ratio, 95% CI:3.96, 3.43-4.56, P <.001). Conclusions: There is a gradual increase in the incidence of the need for early dialysis after LT, and these patients have significantly worse early and late survival. Several pre-transplant recipient characteristics are independently associated with the need for dialysis.

KW - 1-year survival

KW - 5-year survival

KW - chronic kidney disease

KW - lung allocation score

KW - recipient characteristics

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DO - 10.1111/ctr.13106

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