Donor and Procedural Factors on Early Dialysis Trends After Lung Transplantation in the United States

Acute kidney injury requiring dialysis after lung transplantation (LT) is a serious complication associated with poor outcomes. While prior studies have emphasized recipient factors, the effects of donor and procedural variables are less understood.

We analyzed United Network for Organ Sharing registry data on adult LT recipients from 2017 to 2022 (n = 14 999). Multivariable logistic regression identified predictors of early dialysis during the index hospitalization. Kaplan-Meier and Cox regression assessed survival. A subgroup analysis examined 1-y mortality among dialysis recipients.

Early dialysis occurred in 8.9% of recipients, with substantial center and regional variability (5.2%-13%). Independent predictors included lower pretransplant estimated glomerular filtration rate, Black race, vascular disease, intensive care unit admission, mechanical ventilation or extracorporeal membrane oxygenation, and lung allocation score >40. Notably, extended criteria donors, donation after circulatory death, bilateral LT, and ischemic time >7 h were donor and procedural variables also independently associated with dialysis need. Early dialysis was associated with longer hospitalization (median 57 versus 18 d; P < 0.001), increased extracorporeal membrane oxygenation use (39.7% versus 6%), a higher incidence of stroke (9% versus 2.1%), and reduced survival (adjusted hazard ratio, 3.85; 95% confidence interval, 3.56-4.17). Among those requiring dialysis, age >65, ischemic time >7 h, and single LT predicted higher 1-y mortality.

The incidence of early dialysis after LT has increased by >50% in the past decade. Donor and procedural factors now significantly contribute to dialysis risk and should be integrated into perioperative planning and donor-recipient matching to improve outcomes.