中国单中心队列研究：肺移植后急性肾损伤的患病率、危险因素和预后。

The Prevalence, Risk Factors, and Prognosis of Acute Kidney Injury After Lung Transplantation: A Single-Center Cohort Study in China.

机构信息

The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China.

出版信息

Transplant Proc. 2021 Mar;53(2):686-691. doi: 10.1016/j.transproceed.2020.10.031. Epub 2020 Dec 15.

DOI:10.1016/j.transproceed.2020.10.031

PMID:33334610

Abstract

PURPOSE

The aim of this study is to evaluate the incidence, risk factors, and prognosis of acute kidney injury (AKI) after lung transplantation (LTx).

METHODS

Records of patients who underwent LTx in a single center were retrospectively reviewed. The prevalence of post-transplant AKI, the use of continuous renal replacement therapy (CRRT), and the risk factors for AKI were investigated. The effects of AKI and CRRT on short-term outcomes and long-term survival were measured.

RESULTS

This study included 148 patients, 67 of which developed postoperative AKI. Of these, 31 patients underwent CRRT; the percentage of cases with no AKI was 6.2%, and the percentage of cases with stage 1, 2, and 3 who used CRRT was 0%, 10%, and 86.2%, respectively. Patients with AKI had significantly higher intensive care unit mortality and in-hospital mortality. The 1-year post-LTx survival rate of patients with AKI was 47.8%, significantly lower than those without AKI (74.1%). There was no difference in 1-year survival rate of those with stage 1 and stage 2 AKI, but patients with stage 3 AKI showed the worst survival. Patients who underwent CRRT had an inferior survival outcome (9.7% vs 76.1%, P < .05). We found that higher acute physiologic assessment and chronic health evaluation (APACHE) II scores (odds ratio [OR] 1.082, P = .009) and higher intraoperative fluid balance (OR 1.001, P = .012) were independent risk factors, and female sex (OR 2.539) and pulmonary hypertension (OR 2.869) were potential risk factors for post-LTx AKI. A prediction model integration of the above factors showed a good concordance with actual risks and had a concordance index (C-index) of 0.76 (95% confidence interval [CI], 0.66-0.87).

CONCLUSION

Severe AKI requiring CRRT had a negative impact on the short-term and long-term outcomes of patients.

摘要

目的

本研究旨在评估肺移植（LTx）后急性肾损伤（AKI）的发生率、风险因素和预后。

方法

回顾性分析单中心接受 LTx 的患者的病历。调查了移植后 AKI 的发生率、连续性肾脏替代疗法（CRRT）的应用以及 AKI 的风险因素。测量了 AKI 和 CRRT 对短期结局和长期生存的影响。

结果

本研究纳入了 148 名患者，其中 67 名患者发生术后 AKI。其中，31 名患者接受了 CRRT；无 AKI 的比例为 6.2%，AKI 分期 1、2 和 3 期分别采用 CRRT 的比例为 0%、10%和 86.2%。AKI 患者的重症监护室死亡率和院内死亡率显著更高。AKI 患者的 1 年 LTx 后生存率为 47.8%，明显低于无 AKI 患者（74.1%）。AKI 分期 1 期和 2 期患者的 1 年生存率无差异，但 AKI 分期 3 期患者的生存状况最差。接受 CRRT 的患者生存结局较差（9.7%比 76.1%，P<0.05）。我们发现，较高的急性生理和慢性健康评估（APACHE）Ⅱ评分（比值比 [OR] 1.082，P=0.009）和术中液体平衡较高（OR 1.001，P=0.012）是独立的风险因素，而女性（OR 2.539）和肺动脉高压（OR 2.869）是移植后 AKI 的潜在风险因素。上述因素的预测模型整合与实际风险具有良好的一致性，一致性指数（C 指数）为 0.76（95%置信区间 [CI]，0.66-0.87）。