Early implementation of renal replacement therapy after lung transplantation does not impair long-term kidney function in patients with idiopathic pulmonary arterial hypertension

Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved..

OBJECTIVES: In patients with idiopathic pulmonary arterial hypertension, cardiac function can be impaired in the early postoperative phase after lung transplantation because the chronically untrained left ventricle is prone to fail. Thus, restrictive fluid management is pivotal to unload the left heart. In our institution, continuous renal replacement therapy is implemented liberally whenever a patient cannot be balanced negatively. It remains unclear whether such strategy impairs long-term kidney function.

METHODS: We retrospectively reviewed our institutional database for patients with idiopathic pulmonary arterial hypertension who underwent transplantation between 2000 and 2018. The impact of postoperative continuous renal replacement therapy on long-term outcomes was investigated using a linear mixed model and multivariable Cox regression.

RESULTS: A total of 87 idiopathic pulmonary arterial hypertension lung transplant recipients were included in this analysis. In 38 patients (43%), continuous renal replacement therapy was started in the early postoperative period for a median of 16 days (10-22). In this group, urine production significantly decreased and patients began to acquire a positive fluid balance; however, homeostatic functions of the kidney were still preserved at the time of continuous renal replacement therapy initiation. All patients were successfully weaned from continuous renal replacement therapy and fully recovered their kidney function at the time of hospital discharge. No difference in kidney function was found between continuous renal replacement therapy and noncontinuous renal replacement therapy in patients within 5 years.

CONCLUSIONS: Early implementation of continuous renal replacement therapy for perioperative volume management does not impair long-term kidney function in idiopathic pulmonary arterial hypertension lung transplant recipients. Our data suggest that such a strategy leads to excellent long-term outcomes.

Errataetall:

CommentIn: J Thorac Cardiovasc Surg. 2022 Feb;163(2):536-537. - PMID 34175117

Medienart:

E-Artikel

Erscheinungsjahr:

2022

Erschienen:

2022

Enthalten in:

Zur Gesamtaufnahme - volume:163

Enthalten in:

The Journal of thoracic and cardiovascular surgery - 163(2022), 2 vom: 15. Feb., Seite 524-535.e3

Sprache:

Englisch

Beteiligte Personen:

Benazzo, Alberto [VerfasserIn]
Bajorek, Lukas [VerfasserIn]
Morscher, Annika [VerfasserIn]
Schrutka, Lore [VerfasserIn]
Schaden, Eva [VerfasserIn]
Klepetko, Walter [VerfasserIn]
Hoetzenecker, Konrad [VerfasserIn]
Vienna Lung Transplantation Program [VerfasserIn]
Schwarz, Stefan [Sonstige Person]
Schweiger, Thomas [Sonstige Person]
Faybik, Peter [Sonstige Person]
Krenn, Claus [Sonstige Person]
Bacher, Adreas [Sonstige Person]
Moser, Bernhard [Sonstige Person]
Matilla, Jose [Sonstige Person]
Lang, György [Sonstige Person]
Taghavi, Shahrokh [Sonstige Person]
Jaksch, Peter [Sonstige Person]

Links:

Volltext

Themen:

Continuous renal replacement therapy
Idiopathic pulmonary arterial hypertension
Journal Article
Lung transplantation
Video-Audio Media

Anmerkungen:

Date Completed 31.01.2022

Date Revised 31.01.2022

published: Print-Electronic

CommentIn: J Thorac Cardiovasc Surg. 2022 Feb;163(2):536-537. - PMID 34175117

Citation Status MEDLINE

doi:

10.1016/j.jtcvs.2021.05.034

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM326923144