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

Background: 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. Methods: 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. Results: 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; Conclusions: 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.