Cell Cycle Arrest Proteins for Early Diagnosis of Acute Kidney Injury After Solid Organ Transplant: a Prospective Observational Study

Bilateral lung transplantation (LUTX) is a surgical procedure offered to patients suffering from chronic respiratory failure. LUTX provides a survival benefit to selected patients but is associated with several short-term and long-term non-pulmonary complications.

Liver Transplantation (OLTX) is the gold-standard treatment for patients affected by end-stage liver disease or primary liver tumor. Despite its encouraging post-transplant survival, the increasing use of extended criteria donors leads to a higher incidence of post-LT complications that could affect post-LT results and quality of life.

Acute kidney failure (AKI) is frequent and associated with short-term and long-term morbidity and increased mortality. Indeed, AKI occurs in up to two-thirds of transplanted patients, with 5-13% needing renal replacement therapy (RRT), and associated with mortality ranging from 13 to 50%.

Several risk factors may favor postoperative AKI in patients undergoing solid organ transplant: preoperative (e.g., the patients' preoperative renal function and comorbidities) , intraoperative (i.e., hypoxia, hypotension, massive blood components' transfusions, use of intraoperative extracorporeal membrane oxygenation - ECMO) and postoperative (i.e., use of nephrotoxic agents as tacrolimus and antibiotics).

In patients treated with solid organ transplant, postoperative AKI increases ICU and hospital length of stay and is associated with worsened survival. At the same time, postoperative AKI is associated with an increase in end-stage renal failure and consequent chronic renal failure with potential needs of chronic RRT. Finally, AKI may determine graft dysfunction with direct and indirect mechanisms (i.e., inability to reach therapeutic targets of anti-rejection drugs).