ACUTE KIDNEY INJURY AND CRRT IN LUNG TRANSPLANT RECIPIENTS: INSIGHTS FROM A MEXICAN SINGLE-CENTER EXPERIENCE

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Abstract Title *

ACUTE KIDNEY INJURY AND CRRT IN LUNG TRANSPLANT RECIPIENTS: INSIGHTS FROM A MEXICAN SINGLE-CENTER EXPERIENCE

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Co-author 1

Mariana Zavala-Gómez mariana.zavala@udem.edu Hospital Universitario José Euleterio González Nephrology Monterrey Mexico *

Co-author 2

Ricardo Garza-Trevino ricardogarza1999@gmail.com Hospital Christus Muguerza Alta Especialidad Internal Medicine Monterrey Mexico -

Co-author 3

Paola Borbolla-Flores pborbollaf@gmail.com Hospital Universitario José Euleterio González Nephrology Monterrey Mexico -

Co-author 4

Sergio Sánchez-Salazar dr.sergio.saul.sanchez@gmail.com Christus Muguerza Alta Especialidad. Monterrey Lung Transplant Program Monterrey Mexico -

Co-author 5

Uriel Chavarria-Martinez uriel_chavarria@hotmail.com Christus Muguerza Alta Especialidad. Monterrey Lung Transplant Program Monterrey Mexico -

Co-author 6

Manuel Wong-Jaen manuel.wong@christus.mx Christus Muguerza Alta Especialidad. Monterrey Lung Transplant Program Monterrey Mexico -

Co-author 7

Lilia M Rizo-Topete lilia.rizo@udem.edu Christus Muguerza Alta Especialidad. Monterrey Nephrology Monterrey Mexico -

Co-author 8

Adrian Camacho-Ortiz PhD acamacho_md@yahoo.com Christus Muguerza Alta Especialidad. Monterrey Lung Transplant Program Monterrey Mexico -

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Lung transplantation is the standard therapy for end-stage pulmonary disease. In Mexico, the CHRISTUS Muguerza Lung Transplant Program, established in 2017, is the only active program in our country. Despite advances in perioperative care, acute kidney injury (AKI) remains a common complication. AKI can occur before, during, or after surgery and is associated with prolonged ICU stay, higher infection risk, need for renal replacement therapy (RRT), and increased mortality.

Methods

We performed a retrospective analysis of patients undergoing lung transplantation at CHRISTUS Muguerza. Demographic, perioperative, and postoperative data were collected, including AKI incidence, etiology, severity (KDIGO), CRRT requirement, modality, and outcomes.

Results

Thirty-seven patients were included, 26 (70.3%) male, mean age 54.9 ± 11.7 years, mean BMI 24.5 ± 4.3 kg/m². ECMO support was frequent (median 4 days, IQR 2–25) as was vasopressor use. Surgical bleeding exceeded 2500 mL in 51.3% and median ICU stay was 12 days (IQR 6–26). Postoperative CRRT was required in 12 patients (60%). Main indications were oliguria (33.3%), fluid overload (25.0%), azotemia (16.7%), sepsis or septic shock (16.7%), and anuria (8.3%). Two patients (16.7%) met KDIGO stage 2, and 10 (83.3%) KDIGO stage 3. CVVHDF was the predominant CRRT modality (83.3%), with OXIRIS filters in 66.7%. Among patients receiving CRRT, 7 (58%) survived with renal recovery. Figure 1.

Conclusion

AKI is a frequent and significant complication after lung transplantation, with a 60% incidence of CRRT and predominance of severe injury (KDIGO 3). Oliguria and fluid overload were the most common etiologies, often associated with sepsis and major perioperative bleeding. Pre-existing kidney dysfunction and perioperative hemodynamic instability should be assessed with an organ crosstalk perspective. Notably, renal recovery is achievable in a substantial proportion of patients when pulmonary function is successfully restored.

Kewords