# Clinical and molecular epidemiology of acute kidney injury after lung transplant

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2021 · $652,060

## Abstract

PROJECT SUMMARY/ABSTRACT
Acute kidney injury (AKI), rapid loss of renal function over several days, occurs in up to 70% of lung transplant
recipients postoperatively, far more common than after cardiac surgery despite a younger population with
almost no pre-existing chronic kidney disease (CKD). While post-transplant AKI is associated with subsequent
CKD and mortality, it is unclear if AKI impacts outcomes independently or is simply an epiphenomenon of lung
allograft dysfunction and other early transplant complications. Knowledge of post-transplant AKI epidemiology
is limited to relatively small, retrospective, single-center studies with limited assessment of AKI risk factors.
Clarifying AKI’s independent impact on outcomes and identifying patients at high risk of AKI, particularly the
severe forms more strongly linked to CKD and mortality, is critical since renal-protective strategies such as
fluid administration carry risk to the allograft. Blood and urine biomarkers have shown predictive utility for AKI
in critical illness and cardiac surgery populations but have not been studied in lung transplant patients. These
predictive markers may also shed light on mechanisms underlying the high rate of AKI in this population.
The Lung Transplant Outcomes Group (LTOG) is an NIH-funded multicenter prospective cohort started in
2002, coordinated by our institution and designed to study the clinical and molecular epidemiology of primary
graft dysfunction (PGD), an acute lung allograft injury syndrome. With enrollment >2000, the LTOG is uniquely
suited to support an ancillary, multicenter study of AKI epidemiology. We conducted pilot studies of clinical and
plasma biomarker risk factors for AKI in a small group of LTOG subjects. Based on these studies and existing
literature, we hypothesize that distinct clinical and molecular characteristics are associated with AKI
after lung transplantation, with implications for AKI pathogenesis. We further hypothesize that these
characteristics can be used to predict AKI risk to identify candidates for risk reduction strategies.
Utilizing the robust multicenter structure of the LTOG to conduct a study 3 times the size of the largest to date,
we propose the following aims in the lung transplant population: 1) Determine clinical risk factors for and
outcomes of AKI, 2) Determine the association of established and novel plasma and urine biomarkers
with AKI, and 3) Derive and validate predictive models for AKI. This proposal leverages the research
investments already made in the LTOG in order to produce the first comprehensive study of AKI after lung
transplant to establish the independent impact of AKI on outcomes, determine modifiable AKI risk factors,
identify plasma and urine molecular markers associated with AKI, and enable AKI prediction. Completion of the
aims will create a flexible infrastructure within the LTOG to support trials of current and novel renal-protective
peri-transplant management strategies targeted to...

## Key facts

- **NIH application ID:** 10231197
- **Project number:** 5R01DK111638-05
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Michael G. S. Shashaty
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $652,060
- **Award type:** 5
- **Project period:** 2017-09-01 → 2024-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10231197

## Citation

> US National Institutes of Health, RePORTER application 10231197, Clinical and molecular epidemiology of acute kidney injury after lung transplant (5R01DK111638-05). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10231197. Licensed CC0.

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