Grins Edgars, Wijk Johanna, Bjursten Henrik, Zeaiter Maria, Lindstedt Sandra, Dellgren Göran, Ederoth Per, Lannemyr Lukas
Department of Anesthesiology and Intensive Care, Department of Clinical Sciences, Lund University, Lund, Sweden.
Department of Cardiothoracic and Vascular Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden.
Acta Anaesthesiol Scand. 2025 Apr;69(4):e70014. doi: 10.1111/aas.70014.
Acute kidney injury (AKI) is a serious complication after lung transplantation, but the reported incidence varies in the literature. No data on AKI have been published from the Swedish lung transplantation program.
The aim of our study was to investigate the incidence, perioperative risk factors, and effects of early postoperative acute kidney injury (Kidney Disease Improving Global Outcomes [KDIGO] criteria) after lung transplantation. A retrospective, nationwide study of 568 lung-transplanted patients in Sweden between 2011 and 2020 was performed.
The incidence of AKI (any grade) was 42%. Renal replacement therapy was used in 5% of the patients. Preoperative factors independently associated with increased incidence of AKI were higher body mass index (odds ratio [OR]: 1.07, 95% CI: 1.02, 1.12) longer time on transplantation waiting list (OR: 1.05 [1.01, 1.09]), re-transplantation (OR: 2.24 [1.05, 4.80]) and moderate to severe tricuspid regurgitation (OR: 2.61 [1.36, 5.03]). Intraoperative factors independently associated with increased incidence of AKI were use of cardiopulmonary bypass (OR: 2.70 [1.57, 4.63]), increasing number of transfused red blood cell units, and use of immunosuppressive therapy other than routine (OR: 2,56 [1.47, 4.46]). A higher diuresis (OR: 0.70, 95% CI: 0.58-0.85) was associated with less incidence of acute kidney injury. Development of AKI was associated with increased time to extubation (median 30 h, IQR [9, 118] vs. 6 [3, 16]), length of stay in the intensive care unit (9 days [4, 25] vs. 3 [2, 5]) and increased rate of primary graft dysfunction (OR 2.33 [1.66, 3.29]) and 30-day mortality (OR: 10.8 [3.0, 69]).
Acute kidney injury is common after lung transplantation and affects clinical outcomes negatively. Preoperative factors may be used for risk assessment. The use of cardiopulmonary bypass is a potentially modifiable intraoperative risk factor.
Acute kidney injury is a common complication after lung transplantation that severely influences patient outcomes. This large study of more than 500 patients treated over a decade identified potentially modifiable factors associated with the development of acute kidney injury.
急性肾损伤（AKI）是肺移植术后一种严重的并发症，但文献报道的发病率各不相同。瑞典肺移植项目尚未发表关于AKI的数据。
我们研究的目的是调查肺移植术后急性肾损伤（采用改善全球肾脏病预后组织[KDIGO]标准）的发病率、围手术期危险因素及影响。对2011年至2020年期间瑞典568例肺移植患者进行了一项全国性的回顾性研究。
AKI（任何级别）的发病率为42%。5%的患者使用了肾脏替代治疗。与AKI发病率增加独立相关的术前因素包括较高的体重指数（比值比[OR]：1.07，95%置信区间[CI]：1.02，1.12）、在移植等待名单上的时间较长（OR：1.05[1.01，1.09]）、再次移植（OR：2.24[1.05，4.80]）以及中度至重度三尖瓣反流（OR：2.61[1.36，5.03]）。与AKI发病率增加独立相关的术中因素包括使用体外循环（OR：2.70[1.57，4.63]）、输注红细胞单位数量增加以及使用非常规免疫抑制治疗（OR：2.56[1.47，4.46]）。较高的尿量（OR：0.70，95%CI：0.58 - 0.85）与急性肾损伤发病率较低相关。AKI的发生与拔管时间延长（中位数30小时，四分位数间距[IQR][9，118]对6[3，16]）、重症监护病房住院时间延长（9天[4，25]对3[2，5]）以及原发性移植功能障碍发生率增加（OR 2.33[1.66，3.29]）和30天死亡率增加（OR：10.8[3.0，69]）相关。
急性肾损伤在肺移植术后很常见，并对临床结局产生负面影响。术前因素可用于风险评估。使用体外循环是一个潜在可改变的术中危险因素。
急性肾损伤是肺移植术后常见的并发症，严重影响患者预后。这项对十多年来500多名患者的大型研究确定了与急性肾损伤发生相关的潜在可改变因素。
