Toyoda Takahide, Thomae Benjamin Louis, Kandula Viswajit, Manerikar Adwaiy Jayant, Yagi Yuriko, Cerier Emily Jeong, Tomic Rade, Budinger G R Scott, Bharat Ankit, Kurihara Chitaru
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
J Thorac Dis. 2023 Jul 31;15(7):3751-3763. doi: 10.21037/jtd-23-256. Epub 2023 Jun 29.
Primary graft dysfunction (PGD) and acute kidney injury (AKI) are major early complications of lung transplantation and are associated with increased mortality. Lung injury after PGD can contribute to renal dysfunction; however, the association between PGD and AKI severity has not been thoroughly investigated. We analyzed the association between PGD grading and AKI staging, and the impact of AKI on subsequent changes to chronic kidney disease (CKD), including glomerular filtration rate (GFR), over time.
This was a retrospective review of a single-center lung transplantation database between January 2018 and June 2022. AKI and GFR categories were classified according to the Kidney Disease: Improving Global Outcomes criteria. Spearman's and Kaplan-Meier tests were used to compare disease severity and assess survival.
In a total of 206 patients: 119 (57.8%), 25 (12.1%), 34 (16.5%), and 28 (13.6%) had PGD grades 0, 1, 2, and 3, respectively; 96 (46.6%), 47 (22.8%), 27 (13.1%), and 36 (17.5%) had AKI stages 0, 1, 2, and 3, respectively. Twenty-one of the 28 patients (75.0%) with PGD grade 3 had AKI stage 3. There was a significant correlation between PGD grade and AKI stage (P<0.001). There was also a significant correlation between AKI stage and GFR category of CKD at 3, 6, 9, and 12 months after lung transplantation (all P<0.001). For all AKI stages, GFR categories worsened with postoperative time.
PGD grade was significantly correlated with AKI stage, and AKI stage was correlated with GFR categories of CKD.
原发性移植肺功能障碍（PGD）和急性肾损伤（AKI）是肺移植的主要早期并发症，且与死亡率增加相关。PGD后的肺损伤可导致肾功能障碍；然而，PGD与AKI严重程度之间的关联尚未得到充分研究。我们分析了PGD分级与AKI分期之间的关联，以及AKI对慢性肾脏病（CKD）后续变化（包括肾小球滤过率（GFR））随时间的影响。
这是一项对2018年1月至2022年6月单中心肺移植数据库的回顾性研究。AKI和GFR类别根据改善全球肾脏病预后组织（KDIGO）标准进行分类。采用Spearman检验和Kaplan-Meier检验比较疾病严重程度并评估生存率。
总共206例患者中，分别有119例（57.8%）、25例（12.1%）、34例（16.5%）和28例（13.6%）的PGD分级为0、1、2和3级；分别有96例（46.6%）、47例（22.8%）、27例（13.1%）和36例（17.5%）的AKI分期为0、1、2和3期。28例PGD 3级患者中有21例（75.0%）的AKI分期为3期。PGD分级与AKI分期之间存在显著相关性（P<0.001）。肺移植后3、6、9和12个月时，AKI分期与CKD的GFR类别之间也存在显著相关性（均P<0.001）。对于所有AKI分期，GFR类别随术后时间而恶化。
PGD分级与AKI分期显著相关，且AKI分期与CKD的GFR类别相关。
