A risk score to predict acute renal failure in adult patients after lung transplantation

Joshua C. Grimm, Cecillia Lui, Arman Kilic, Vicente Valero, Christopher M. Sciortino, Glenn Whitman, Ashish S. Shah

Research output: Contribution to journalArticle

Abstract

Background Despite the significant morbidity associated with renal failure after lung transplantation (LTx), no predictive models currently exist. Accordingly, the purpose of this study was to develop a preoperative risk score based on recipient-, donor-, and transplant-specific characteristics to predict postoperative acute renal failure in candidates for transplantation. Methods The United Network of Organ Sharing (UNOS) database was queried for adult patients (≥ 18 years of age) undergoing LTx between 2005 and 2012. The population was randomly divided into derivation (80%) and validation (20%) cohorts. The primary outcome of interest was new-onset renal failure. Variables predictive of acute renal failure (exploratory p value <0.2) within the derivation cohort were incorporated into a multivariable logistic regression model. Odds ratios were used to assign values to the independent predictors of postoperative renal failure to construct the risk stratification score (RSS). Results During the study period, 10,963 patients underwent lung transplantation, and the incidence of renal failure was 5.5% (598 patients). Baseline recipient-, donor-, and transplant-related factors were similar between the cohorts. Eighteen covariates were included in the multivariable model, and 10 were assigned values based on their relative odds ratios (ORs). Scores were stratified into 3 groups, with an observed rate of acute renal failure of 3.1%, 5.3%, and 15.6% in the low-, moderate-, and high-risk groups, respectively. The incidence of renal failure was found to be significantly increased in the highest risk group (p <0.001). Furthermore, the risk model's predicted rates of renal failure highly correlated with actual rates observed in the population (r = 0.86). Conclusions We introduce a novel and simple RSS that is highly predictive of renal failure after LTx.

Original languageEnglish (US)
Pages (from-to)251-257
Number of pages7
JournalAnnals of Thoracic Surgery
Volume99
Issue number1
DOIs
StatePublished - Jan 1 2015

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Lung Transplantation
Acute Kidney Injury
Renal Insufficiency
Odds Ratio
Logistic Models
Tissue Donors
Incidence
Population
Transplantation
Databases
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

A risk score to predict acute renal failure in adult patients after lung transplantation. / Grimm, Joshua C.; Lui, Cecillia; Kilic, Arman; Valero, Vicente; Sciortino, Christopher M.; Whitman, Glenn; Shah, Ashish S.

In: Annals of Thoracic Surgery, Vol. 99, No. 1, 01.01.2015, p. 251-257.

Research output: Contribution to journalArticle

Grimm, Joshua C. ; Lui, Cecillia ; Kilic, Arman ; Valero, Vicente ; Sciortino, Christopher M. ; Whitman, Glenn ; Shah, Ashish S. / A risk score to predict acute renal failure in adult patients after lung transplantation. In: Annals of Thoracic Surgery. 2015 ; Vol. 99, No. 1. pp. 251-257.
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abstract = "Background Despite the significant morbidity associated with renal failure after lung transplantation (LTx), no predictive models currently exist. Accordingly, the purpose of this study was to develop a preoperative risk score based on recipient-, donor-, and transplant-specific characteristics to predict postoperative acute renal failure in candidates for transplantation. Methods The United Network of Organ Sharing (UNOS) database was queried for adult patients (≥ 18 years of age) undergoing LTx between 2005 and 2012. The population was randomly divided into derivation (80{\%}) and validation (20{\%}) cohorts. The primary outcome of interest was new-onset renal failure. Variables predictive of acute renal failure (exploratory p value <0.2) within the derivation cohort were incorporated into a multivariable logistic regression model. Odds ratios were used to assign values to the independent predictors of postoperative renal failure to construct the risk stratification score (RSS). Results During the study period, 10,963 patients underwent lung transplantation, and the incidence of renal failure was 5.5{\%} (598 patients). Baseline recipient-, donor-, and transplant-related factors were similar between the cohorts. Eighteen covariates were included in the multivariable model, and 10 were assigned values based on their relative odds ratios (ORs). Scores were stratified into 3 groups, with an observed rate of acute renal failure of 3.1{\%}, 5.3{\%}, and 15.6{\%} in the low-, moderate-, and high-risk groups, respectively. The incidence of renal failure was found to be significantly increased in the highest risk group (p <0.001). Furthermore, the risk model's predicted rates of renal failure highly correlated with actual rates observed in the population (r = 0.86). Conclusions We introduce a novel and simple RSS that is highly predictive of renal failure after LTx.",
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AU - Whitman, Glenn

AU - Shah, Ashish S.

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N2 - Background Despite the significant morbidity associated with renal failure after lung transplantation (LTx), no predictive models currently exist. Accordingly, the purpose of this study was to develop a preoperative risk score based on recipient-, donor-, and transplant-specific characteristics to predict postoperative acute renal failure in candidates for transplantation. Methods The United Network of Organ Sharing (UNOS) database was queried for adult patients (≥ 18 years of age) undergoing LTx between 2005 and 2012. The population was randomly divided into derivation (80%) and validation (20%) cohorts. The primary outcome of interest was new-onset renal failure. Variables predictive of acute renal failure (exploratory p value <0.2) within the derivation cohort were incorporated into a multivariable logistic regression model. Odds ratios were used to assign values to the independent predictors of postoperative renal failure to construct the risk stratification score (RSS). Results During the study period, 10,963 patients underwent lung transplantation, and the incidence of renal failure was 5.5% (598 patients). Baseline recipient-, donor-, and transplant-related factors were similar between the cohorts. Eighteen covariates were included in the multivariable model, and 10 were assigned values based on their relative odds ratios (ORs). Scores were stratified into 3 groups, with an observed rate of acute renal failure of 3.1%, 5.3%, and 15.6% in the low-, moderate-, and high-risk groups, respectively. The incidence of renal failure was found to be significantly increased in the highest risk group (p <0.001). Furthermore, the risk model's predicted rates of renal failure highly correlated with actual rates observed in the population (r = 0.86). Conclusions We introduce a novel and simple RSS that is highly predictive of renal failure after LTx.

AB - Background Despite the significant morbidity associated with renal failure after lung transplantation (LTx), no predictive models currently exist. Accordingly, the purpose of this study was to develop a preoperative risk score based on recipient-, donor-, and transplant-specific characteristics to predict postoperative acute renal failure in candidates for transplantation. Methods The United Network of Organ Sharing (UNOS) database was queried for adult patients (≥ 18 years of age) undergoing LTx between 2005 and 2012. The population was randomly divided into derivation (80%) and validation (20%) cohorts. The primary outcome of interest was new-onset renal failure. Variables predictive of acute renal failure (exploratory p value <0.2) within the derivation cohort were incorporated into a multivariable logistic regression model. Odds ratios were used to assign values to the independent predictors of postoperative renal failure to construct the risk stratification score (RSS). Results During the study period, 10,963 patients underwent lung transplantation, and the incidence of renal failure was 5.5% (598 patients). Baseline recipient-, donor-, and transplant-related factors were similar between the cohorts. Eighteen covariates were included in the multivariable model, and 10 were assigned values based on their relative odds ratios (ORs). Scores were stratified into 3 groups, with an observed rate of acute renal failure of 3.1%, 5.3%, and 15.6% in the low-, moderate-, and high-risk groups, respectively. The incidence of renal failure was found to be significantly increased in the highest risk group (p <0.001). Furthermore, the risk model's predicted rates of renal failure highly correlated with actual rates observed in the population (r = 0.86). Conclusions We introduce a novel and simple RSS that is highly predictive of renal failure after LTx.

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