Division of Thoracic Surgery, Centre Hospitalier de l'Université de Montréal, and Montreal Heart Institute Research Center, Université de Montréal, Montréal, Quebec, Canada.
Eur J Cardiothorac Surg. 2012 Jan;41(1):193-9. doi: 10.1016/j.ejcts.2011.04.034.
Acute renal failure (ARF) frequently complicates lung transplantation. This study determined the prevalence, predictive factors, and consequences of ARF on long-term renal function and survival.
One hundred and seventy-four lung transplantation recipients were divided into two groups based on the presence or absence of ARF defined as a 50% decrease in creatinine clearance from baseline (group I: 67 patients with ARF; group II: 107 patients without ARF). Multivariate analysis compared pre-operative, operative, and post-operative risk factors to assess predictive factors. Renal function over time was assessed by two-way repeated measures analysis of variance (ANOVA).
ARF developed in 67 (39%) of patients. Multivariate analysis identified aprotinin (OR 2.20 (1.11; 4.36), p=0.02) and double lung transplantation (OR 2.61 (1.32; 5.15), p=0.006) as risk factors for post-operative renal failure. At 5 years following transplant, creatinine clearance was similar between the two groups (group I CrCl: 73 ml s(-1); group II CrCl: 53 ml s(-1); p=0.54). Survival at 5 years was the same in the two groups. Multivariate analysis associated age at the time of transplantation (HR 1.030 (1.004; 1.057), p=0.02) and intensive care unit (ICU) length of stay (HR 1.029 (1.008; 1.051), p=0.007) with decreased survival.
The use of aprotinin and double lung transplantation are associated with ARF following lung transplantation. Age at the time of transplantation and a longer intensive care stay predict decreased survival. ARF after lung transplantation is not predictive of late renal dysfunction or decreased long-term survival.
急性肾衰竭（ARF）常并发于肺移植。本研究旨在确定 ARF 的发生率、预测因素及其对长期肾功能和存活率的影响。
根据基线肌酐清除率下降 50%（ARF 组：67 例患者；非 ARF 组：107 例患者）将 174 例肺移植受者分为两组。多变量分析比较术前、术中和术后的危险因素，以评估预测因素。采用双向重复测量方差分析（ANOVA）评估随时间推移的肾功能变化。
67 例（39%）患者发生 ARF。多变量分析发现抑肽酶（OR 2.20（1.11；4.36），p=0.02）和双肺移植（OR 2.61（1.32；5.15），p=0.006）是术后发生肾衰竭的危险因素。移植后 5 年，两组的肌酐清除率相似（ARF 组 CrCl：73ml/s；非 ARF 组 CrCl：53ml/s；p=0.54）。两组 5 年存活率相同。多变量分析发现，移植时的年龄（HR 1.030（1.004；1.057），p=0.02）和重症监护病房（ICU）住院时间（HR 1.029（1.008；1.051），p=0.007）与存活率降低相关。
抑肽酶和双肺移植与肺移植后 ARF 相关。移植时的年龄和 ICU 住院时间较长预测存活率降低。肺移植后 ARF 不能预测晚期肾功能障碍或降低长期存活率。
