Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China.
Pulmonary and Critical Care Medicine, Nantong First People's Hospital, Nantong 226001, Jiangsu Province, China.
Heart Lung. 2024 Nov-Dec;68:37-45. doi: 10.1016/j.hrtlng.2024.06.008. Epub 2024 Jun 21.
Postoperative acute kidney injury (AKI) after lung transplantation (LTx) is an important factor affecting the short-term outcomes. The focus item of transplantation centers is how to improve the incidence of AKI through optimal management during the perioperative period.
The purpose of the study is to investigate the influence of perioperative volume in the development of early AKI following LTx.
The study involved patients who had undergone LTx between October 2018 to December 2021 at China-Japan Friendship Hospital in Beijing. The patients were monitored for AKI occurring within 72 hours after LTx, as well as the renal outcomes within 30 days. The perioperative volumes were compared and analyzed to determine the impact on various clinical outcomes.
248 patients were enrolled in the study ultimately, with almost half of them (49.6 %) experiencing AKI. 48.8 % of AKI patients received continuous renal replacement therapy (CRRT), with 57.7 % recovered by the end of the 30-day follow-up period. A J-shaped relationship was demonstrated between perioperative volume and AKI incidence. Moreover, maintaining a positive fluid balance would increase the 30-day mortality and lead to poor renal outcomes.
Perioperative volume is an independent risk factor of early AKI after LTx. Positive fluid balance increases the risk of AKI, 30-day mortality, and adverse renal prognosis. The LTx recipients may benefit from a relatively restrict fluid strategy during and after the lung transplantation.
肺移植（LTx）后急性肾损伤（AKI）是影响短期结局的重要因素。移植中心的重点是如何通过围手术期的最佳管理来降低 AKI 的发生率。
本研究旨在探讨围手术期容量对 LTx 后早期 AKI 的影响。
本研究纳入了 2018 年 10 月至 2021 年 12 月期间在北京中日友好医院接受 LTx 的患者。监测患者 LTx 后 72 小时内发生 AKI 以及 30 天内的肾脏结局。比较和分析围手术期容量，以确定其对各种临床结局的影响。
最终纳入 248 例患者，其中近一半（49.6%）发生 AKI。48.8%的 AKI 患者接受了持续肾脏替代治疗（CRRT），其中 57.7%在 30 天随访期结束时恢复。围手术期容量与 AKI 发生率呈 J 形关系。此外，保持正液平衡会增加 30 天死亡率，并导致不良的肾脏结局。
围手术期容量是 LTx 后早期 AKI 的独立危险因素。正液平衡增加了 AKI、30 天死亡率和不良肾脏预后的风险。LTx 受者可能受益于肺移植期间和之后的相对限制液体策略。
