心脏移植术后肾脏替代治疗的危险因素：一项回顾性单中心研究。

Risk factors of renal replacement therapy after heart transplantation: a retrospective single-center study.

作者信息

Xie Bingying, Fu Lei, Wu Yijin, Xie Xinfu, Zhang Wenhao, Hou Jihua, Liu Dinglin, Li Ruizhao, Zhang Li, Zhou Chengbin, Huang Jinsong, Liang Xinling, Wu Min, Ye Zhiming

机构信息

Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

Shantou University Medical College, Shantou, China.

出版信息

Ann Transl Med. 2022 Mar;10(5):257. doi: 10.21037/atm-22-541.

DOI:10.21037/atm-22-541

PMID:35402585

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8987878/

Abstract

BACKGROUND

Acute kidney injury (AKI) and renal replacement therapy (RRT) are common after heart transplantation (HT). The need for RRT has been reported to be one of the most important predictors of a poor prognosis after HT. Therefore, it is important to early identify risk factors of RRT after HT. However, in the heart transplantation setting, the risk factors are less well studied, and some of the conclusions are controversial. This study aimed to identify the clinical predictors of RRT after HT.

METHODS

This single-center, retrospective study from January 2010 to June 2021 analyzed risk factors (pre-, intra-, and postoperative characteristics) of 163 patients who underwent HT. The endpoint of the study was RRT within 7 days of HT. Risk factors were analyzed by multivariable logistic regression models.

RESULTS

Fifty-five (33.74%) recipients required RRT within 7 days of HT. Factors independently associated with RRT after HT were as follows: a baseline estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m [odds ratio (OR) =3.123; 95% confidence interval (CI): 1.183-8.244; P=0.022], a dose of intraoperative methylprednisolone >10 mg/kg (OR =3.197; 95% CI: 1.290-7.923; P=0.012), the use of mechanical circulatory support (MCS) during surgery (OR =4.903; 95% CI: 1.628-14.766; P=0.005), a cardiopulmonary bypass (CPB) time ≥5 hours (OR =3.929; 95% CI: 1.222-12.634; P=0.022), and postoperative serum total bilirubin (TBIL) ≥60 umol/L (OR =5.105; 95% CI: 1.868-13.952; P=0.001). Protective factors were higher postoperative serum albumin (OR =0.907; 95% CI: 0.837-0.983; P=0.017) and higher postoperative left ventricular ejection fraction (LVEF) (OR =0.908; 95% CI: 0.838-0.985; P=0.020).

CONCLUSIONS

A low preoperative eGFR, a high intraoperative dose of methylprednisolone, a long CPB time, the use of mechanical circulatory support, and a high postoperative TBIL were risk factors for RRT after HT. While a high postoperative serum albumin level and a high left ventricular ejection fraction were protective factors. Understanding these risk factors may help us identify high-risk patients and intervene early.

摘要

背景

心脏移植（HT）后急性肾损伤（AKI）和肾脏替代治疗（RRT）很常见。据报道，需要进行RRT是HT后预后不良的最重要预测因素之一。因此，早期识别HT后RRT的危险因素很重要。然而，在心脏移植领域，危险因素的研究较少，且一些结论存在争议。本研究旨在确定HT后RRT的临床预测因素。

方法

这项单中心回顾性研究分析了2010年1月至2021年6月期间163例行HT患者的危险因素（术前、术中和术后特征）。研究终点为HT后7天内进行RRT。通过多变量逻辑回归模型分析危险因素。

结果

55例（33.74%）受者在HT后7天内需要RRT。与HT后RRT独立相关的因素如下：基线估计肾小球滤过率（eGFR）<60 mL/（min·1.73 m²）[比值比（OR）=3.123；95%置信区间（CI）：1.183 - 8.244；P = 0.022]、术中甲基强的松龙剂量>10 mg/kg（OR = 3.197；95% CI：1.290 - 7.923；P = 0.012）、手术期间使用机械循环支持（MCS）（OR = 4.903；95% CI：1.628 - 14.766；P = 0.005）、体外循环（CPB）时间≥5小时（OR = 3.929；95% CI：1.222 - 12.634；P = 0.022）以及术后血清总胆红素（TBIL）≥60 μmol/L（OR = 5.105；95% CI：1.868 - 13.952；P = 0.001）。保护因素为术后血清白蛋白水平较高（OR = 0.907；95% CI：0.837 - 0.983；P = 0.017）和术后左心室射血分数（LVEF）较高（OR = 0.908；95% CI：0.838 - 0.985；P = 0.020）。