Shimada Yoshihisa, Konoeda Chihiro, Cong Yue, Nagano Masaaki, Nakao Keita, Kawashima Mitsuaki, Maeda Akinori, Doi Kent, Ikeda Norihiko, Sato Masaaki
Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
Gen Thorac Cardiovasc Surg. 2025 Aug 28. doi: 10.1007/s11748-025-02193-4.
Renal dysfunction, including acute kidney injury (AKI) and chronic kidney disease (CKD), is a major complication following lung transplantation (LT) and is associated with increased morbidity and mortality. This study aims to evaluate the clinical significance of AKI in relation to the development of post-LT CKD and poor prognosis.
Among 133 patients who underwent LT, 116 were included in the analysis. AKI was defined according to the Kidney Disease Improving Global Outcomes criteria. AKI was classified into early AKI (E-AKI), occurring within a few hours to one week postoperatively, and late AKI (L-AKI), occurring between one week and one month after LT. The Major Adverse Kidney Event within 30 days following LT (MAKE30)-a composite outcome that includes all-cause mortality, new renal replacement therapy, or persistent renal dysfunction-was also used in this study. Univariate and multivariate analyses were conducted to identify factors associated with the development of CKD. Overall survival (OS) was analyzed using the Kaplan-Meier method.
The proportions of patients who developed E-AKI, L-AKI, MAKE30, and CKD were 73%, 31%, 15%, and 46%, respectively. Multivariate analysis identified older age and the occurrence of MAKE30 as independent predictors of post-LT CKD. Notably, all recipients aged 50 years or older who experienced either L-AKI or MAKE30 subsequently developed CKD. In addition, the incidence of MAKE30 was marginally correlated with reduced OS.
The occurrence of L-AKI and MAKE30 following LT is associated with the development of CKD and MAKE30 also has a negative impact on OS.
肾功能不全，包括急性肾损伤（AKI）和慢性肾脏病（CKD），是肺移植（LT）后的主要并发症，与发病率和死亡率增加相关。本研究旨在评估AKI与LT后CKD发生及预后不良的临床意义。
在133例行LT的患者中，116例纳入分析。AKI根据改善全球肾脏病预后组织标准定义。AKI分为早期AKI（E-AKI），发生在术后数小时至1周内，以及晚期AKI（L-AKI），发生在LT后1周与1个月之间。本研究还采用了LT后30天内的主要不良肾脏事件（MAKE30）——一个包括全因死亡率、新的肾脏替代治疗或持续性肾功能不全的复合结局。进行单因素和多因素分析以确定与CKD发生相关的因素。采用Kaplan-Meier法分析总生存期（OS）。
发生E-AKI、L-AKI、MAKE30和CKD的患者比例分别为73%、31%、15%和46%。多因素分析确定年龄较大和发生MAKE30是LT后CKD的独立预测因素。值得注意的是，所有年龄在50岁及以上且经历过L-AKI或MAKE30的受者随后均发生了CKD。此外，MAKE30的发生率与OS降低存在微弱相关性。
LT后发生L-AKI和MAKE30与CKD的发生相关，且MAKE30对OS也有负面影响。
