Cardiac Intensive Care Unit Division, Intensive Care Medicine Department, Universitary Hospital "12 de Octubre", Madrid, Spain.
Cardiology Department, Instituto de Investigación Sanitaria, Universitary Hospital "12 de Octubre" (imas12), Madrid, Spain.
Transplantation. 2018 Nov;102(11):1901-1908. doi: 10.1097/TP.0000000000002293.
Little is known about the incidence of acute kidney injury (AKI), as defined using the Kidney Disease Improving Global Outcome classification, after heart transplantation (HT). Our objective was to evaluate the impact of AKI in a cohort of HT recipients. (Setting: University Hospital.) METHODS: We studied 310 consecutive HT recipients from 1999 to 2017, with AKI being defined according to the Kidney Disease Improving Global Outcome criteria. Risk factors were analyzed by multivariable analyses, and survival by Kaplan-Meier curves and a risk-adjusted Cox proportional hazards regression model.
One hundred twenty-five (40.3%) patients developed AKI, with 73 (23.5%), 18 (5.8%), and 34 (11%) patients having AKI stages 1, 2, and 3, respectively. Cardiac tamponade (odds ratio [OR], 16.82; 95% confidence interval [CI], 1.06-138), acute right ventricular failure (OR, 3.54; 95% CI, 1.82-6.88), and major bleeding (OR, 2.46; 95% CI, 1.18-5.1) were the principal risk factors for AKI. Patients with AKI had a greater hospital mortality (3.8% vs 16%, P < 0.05), especially those requiring renal replacement therapy (46.9% vs 5.4%, P = 0.006). Acute kidney injury requiring renal replacement therapy was independently associated with hospital mortality (OR, 11.03; 95% CI, 4.08-29.8). With a median follow-up after hospital discharge of 6.7 years (interquartile range, 2.4-11.6), overall survival at 1, 5, and 10 years was 95.4%, 85.1%, and 75.4% versus 85.2%, 69.8% and 63.5% among patients without AKI and with AKI stages 2 to 3, respectively (P = 0.08).
The onset of AKI after HT is mainly associated with postoperative complications. Only severe AKI stage predicts worse short-term outcome, with this impact appearing to be lost at long-term follow-up.
使用肾脏疾病改善全球结局（KDIGO）分类标准定义的心脏移植（HT）后急性肾损伤（AKI）的发生率知之甚少。我们的目的是评估 AKI 在 HT 受者队列中的影响。（背景：大学医院。）方法：我们研究了 1999 年至 2017 年连续 310 例 HT 受者，AKI 根据 KDIGO 标准定义。通过多变量分析分析危险因素，通过 Kaplan-Meier 曲线和风险调整 Cox 比例风险回归模型分析生存情况。
125 例（40.3%）患者发生 AKI，其中 73 例（23.5%）、18 例（5.8%）和 34 例（11%）患者 AKI 分期分别为 1、2 和 3。心脏压塞（比值比 [OR]，16.82；95%置信区间 [CI]，1.06-138）、急性右心室衰竭（OR，3.54；95%CI，1.82-6.88）和大出血（OR，2.46；95%CI，1.18-5.1）是 AKI 的主要危险因素。发生 AKI 的患者住院死亡率更高（3.8%比 16%，P<0.05），尤其是需要肾脏替代治疗的患者（46.9%比 5.4%，P=0.006）。需要肾脏替代治疗的 AKI 与住院死亡率独立相关（OR，11.03；95%CI，4.08-29.8）。在出院后中位随访 6.7 年（四分位间距，2.4-11.6）后，无 AKI 和 AKI 2-3 期患者的 1、5 和 10 年总生存率分别为 95.4%、85.1%和 75.4%和 85.2%、69.8%和 63.5%（P=0.08）。
HT 后 AKI 的发生主要与术后并发症有关。只有严重的 AKI 阶段预测短期预后更差，这种影响在长期随访中似乎消失。
