Koh Wonshill, Seo JanDong, Ollberding Nicholas J, Hayes Don
Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
J Heart Lung Transplant. 2025 Sep;44(9):1430-1437. doi: 10.1016/j.healun.2025.02.1681. Epub 2025 Mar 17.
Renal dysfunction is a common postoperative complication following cardiothoracic surgery, including heart and lung transplantation. Among adult lung transplant (LTx) recipients, acute kidney injury is associated with increased morbidity and mortality with those requiring renal replacement therapy having the worst outcome. The prevalence and risk factors for renal failure requiring post-transplant dialysis and its effect on outcomes among children after LTx are unknown, prompting this investigation.
Children less than 18 years of age who underwent LTx between 2000 and 2023 with known post-LTx dialysis status were identified in the United Network for Organ Sharing Registry. Univariate analyses, multivariable Cox regression, logistic regression, and a Kaplan-Meier plot were performed for a comprehensive analysis.
A total of 975 children were identified: 65 requiring post-LTx dialysis. There were no significant differences in demographics between pediatric recipients requiring and not requiring dialysis after LTx. However, children requiring post-LTx dialysis had lower estimated glomerular filtration rate (eGFR) at the time of transplantation (108 vs 132, p = 0.002). Those who were an extracorporeal mechanical oxygenation bridge to LTx, had a previous LTx, or had abnormal eGFR at the time of transplant were at a higher risk for dialysis postoperatively. The cohort requiring post-transplant dialysis had worse 1-, 3-, and 5-year post-LTx survival. A multivariable Cox model demonstrated post-LTx dialysis was associated with a statistically significant increase in mortality (hazard ratios 2.46; 95% confidence interval 1.81, 3.35; p < 0.001).
Renal failure requiring dialysis in children after LTx is associated with significantly worse survival.
肾功能不全是心胸外科手术后常见的并发症，包括心脏和肺移植。在成年肺移植（LTx）受者中，急性肾损伤与发病率和死亡率增加相关，需要肾脏替代治疗的患者预后最差。LTx术后需要透析的肾衰竭在儿童中的患病率、危险因素及其对预后的影响尚不清楚，因此开展了本研究。
在器官共享联合网络登记处中识别出2000年至2023年间接受LTx且已知LTx术后透析状态的18岁以下儿童。进行单因素分析、多变量Cox回归、逻辑回归和Kaplan-Meier曲线分析以进行全面分析。
共识别出975名儿童，其中65名需要LTx术后透析。LTx术后需要透析和不需要透析的儿科受者在人口统计学上无显著差异。然而，需要LTx术后透析的儿童在移植时的估计肾小球滤过率（eGFR）较低（108 vs 132，p = 0.002）。那些作为体外膜肺氧合桥接至LTx、曾接受过LTx或移植时eGFR异常的儿童术后透析风险较高。需要移植后透析的队列在LTx术后1年、3年和5年的生存率较差。多变量Cox模型显示，LTx术后透析与死亡率的统计学显著增加相关（风险比2.46；95%置信区间1.81, 3.35；p < 0.001）。
LTx术后儿童需要透析的肾衰竭与显著更差的生存率相关。
