Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
J Heart Lung Transplant. 2012 Mar;31(3):244-51. doi: 10.1016/j.healun.2011.08.016. Epub 2011 Oct 13.
The effect of acute kidney injury (AKI) after lung transplantation has been described infrequently and with inconsistent results. Using a newly adopted and validated definition of AKI proposed by the Acute Kidney Injury Network (AKIN), we examined the incidence of AKI and associated renal morbidity and short-term and long-term mortality.
We retrospectively evaluated data of 657 patients who underwent lung transplantation from 1997 to 2009. Outcomes analyzed were the incidence of AKI, as defined and categorized into 3 stages according to creatinine criteria from the AKIN classification (AKIN 1, AKIN 2, and AKIN 3), cumulative incidence of chronic kidney disease (CKD), as defined by an estimated glomerular filtration rate ≤ 29 ml/min/1.73 m(2), and/or the onset of end-stage renal disease, as defined by the need for renal replacement therapy for 8 weeks with no recovery on follow-up or need for kidney transplant, and long-term mortality.
We identified 424 patients (65%) who had at least 1 AKI (309 [47%] AKIN 1 and 115 [17%] AKIN 2-3) event in the first 2 weeks after transplantation. At 1 year, the cumulative incidence of CKD was 5.8%, 12.8%, 24.5 % in the no-AKI, AKIN 1, and AKIN 2-3 patients, respectively. After a median follow-up of 2.2 years, 277 (42%) died. One-year patient survival was 91%, 82%, 66% in the no-AKI, AKIN 1, and AKIN 2-3 patients, respectively. Adjusting for age, sex, race, type and cause of lung transplant, diabetes, and hypertension, the hazard ratio for death was 1.7 (95% confidence interval, 1.2-2.2; p = 0.0002) for AKIN 1 and 2.9 (95% confidence interval, 1.7-3.7; p < 0.001) for AKIN 2-3.
AKI is a common complication after lung transplantation and is associated with increased risk of CKD and all cause-mortality on long-term follow-up.
急性肾损伤（AKI）在肺移植后的影响已被描述，但结果不一致。本研究使用急性肾损伤网络（AKIN）提出的新采用和验证的 AKI 定义，检查 AKI 的发生率以及相关的肾脏发病率和短期及长期死亡率。
我们回顾性评估了 1997 年至 2009 年期间接受肺移植的 657 例患者的数据。分析的结果是 AKI 的发生率，根据 AKIN 分类的肌酐标准定义并分为 3 期（AKIN 1、AKIN 2 和 AKIN 3），慢性肾脏病（CKD）的累积发生率，定义为估算肾小球滤过率≤29ml/min/1.73m²，和/或终末期肾病的发生，定义为需要进行 8 周的肾脏替代治疗，在随访中没有恢复或需要进行肾移植，以及长期死亡率。
我们发现 424 例（65%）患者在移植后 2 周内至少发生 1 次 AKI（309 例[47%]AKIN 1 和 115 例[17%]AKIN 2-3）。1 年后，无 AKI、AKIN 1 和 AKIN 2-3 患者的 CKD 累积发生率分别为 5.8%、12.8%和 24.5%。中位随访 2.2 年后，277 例（42%）死亡。无 AKI、AKIN 1 和 AKIN 2-3 患者的 1 年患者生存率分别为 91%、82%和 66%。校正年龄、性别、种族、肺移植类型和病因、糖尿病和高血压后，AKIN 1 的死亡风险比为 1.7（95%置信区间，1.2-2.2；p=0.0002），AKIN 2-3 的死亡风险比为 2.9（95%置信区间，1.7-3.7；p<0.001）。
AKI 是肺移植后的常见并发症，与长期随访时 CKD 和全因死亡率增加相关。
