Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands.
J Heart Lung Transplant. 2012 Mar;31(3):238-43. doi: 10.1016/j.healun.2011.08.013. Epub 2011 Oct 5.
Impaired renal function is a frequent complication after lung transplantation (LTx). Since the early days of LTx, recipient eligibility criteria slowly became less strict, while treatment regimens evolved. These developments may have had opposing effects on the risk for impaired renal function. We aimed to study changes in recipient characteristics in conjunction with incidence of impaired renal function in consecutive series of lung transplant recipients (LTRs).
Three hundred forty adult LTRs (mean age 45 ± 12 years, 50.3% male, median follow-up 3.4 [1.0 to 7.1] years) were divided into four consecutive patient time-series: 1990 to 1996 (n = 93); 1997 to 2001 (n = 79); 2002 to 2005 (n = 89); and 2006 to 2008 (n = 79). The primary end-point was cumulative incidence of doubling of serum creatinine (DSC), taking into account the competing risk of death. Measured glomerular filtration rate (mGFR; (125)I-Iothalamate) was assessed as a secondary end-point.
Mean age at transplantation (p = 0.001), prevalence of hypertension (p = 0.005), pack-years of former smoking (p = 0.001) and body mass index (p = 0.05) increased across the consecutive series. The cumulative incidence of DSC at 24 months after LTx was 43%, 37%, 35% and 29%, respectively, in the consecutive series (p = 0.01). Despite higher prevalence of renal risk factors, there was lower adjusted risk of DSC in the consecutive series, with hazard ratios [95% CI] of 0.62 [0.34 to 1.15], 0.50 [0.25 to 0.98] and 0.31 [0.154 to 0.67], respectively, compared with the 1990 to 1996 series. Accordingly, mGFRs at 24 months after LTx were 51 ± 17, 53 ± 17, 57 ± 21 and 63 ± 21 ml/min/1.73 m(2) in the consecutive series (p = 0.002).
Despite the higher prevalence of renal risk factors in more recently transplanted patients, renal outcome after LTx has improved over time. Nevertheless, impaired renal function remains a frequent complication after LTx.
肾功能障碍是肺移植（LTx）后的常见并发症。自 LTx 早期以来，受者入选标准逐渐放宽，而治疗方案也在不断发展。这些发展可能对肾功能障碍的风险产生了相反的影响。我们旨在研究连续系列肺移植受者（LTR）中受者特征的变化与肾功能障碍发生率之间的关系。
我们将 340 例成年 LTR（平均年龄 45±12 岁，50.3%为男性，中位随访 3.4[1.0 至 7.1]年）分为四个连续的患者时间序列：1990 年至 1996 年（n=93）；1997 年至 2001 年（n=79）；2002 年至 2005 年（n=89）；和 2006 年至 2008 年（n=79）。主要终点是血清肌酐倍增的累积发生率（DSC），同时考虑到死亡的竞争风险。作为次要终点，评估了肾小球滤过率（mGFR；（125）I-碘海醇）。
移植时的平均年龄（p=0.001）、高血压的患病率（p=0.005）、以前吸烟的包年数（p=0.001）和体重指数（p=0.05）在连续系列中均增加。LTx 后 24 个月时，DSC 的累积发生率分别为连续系列中的 43%、37%、35%和 29%（p=0.01）。尽管存在更高的肾功能障碍危险因素，但在连续系列中，DSC 的调整风险较低，风险比[95%CI]分别为 0.62[0.34 至 1.15]、0.50[0.25 至 0.98]和 0.31[0.154 至 0.67]，与 1990 年至 1996 年系列相比。相应地，LTx 后 24 个月时的 mGFR 分别为连续系列中的 51±17、53±17、57±21 和 63±21 ml/min/1.73 m（2）（p=0.002）。
尽管最近移植的患者中肾功能障碍的危险因素更为普遍，但 LTx 后的肾脏预后已得到改善。然而，肾功能障碍仍然是 LTx 后的常见并发症。
