留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

肺移植术后早期急性肾损伤的危险因素及预后分析

陈奥 练巧燕 张建恒 徐鑫 韦兵 蔡宇航 黄丹霞 何建行 巨春蓉

陈奥, 练巧燕, 张建恒, 等. 肺移植术后早期急性肾损伤的危险因素及预后分析[J]. 器官移植, 2021, 12(2): 220-225, 231. doi: 10.3969/j.issn.1674-7445.2021.02.014
引用本文: 陈奥, 练巧燕, 张建恒, 等. 肺移植术后早期急性肾损伤的危险因素及预后分析[J]. 器官移植, 2021, 12(2): 220-225, 231. doi: 10.3969/j.issn.1674-7445.2021.02.014
Chen Ao, Lian Qiaoyan, Zhang Jianheng, et al. Analysis of risk factors and clinical prognosis of acute kidney injury early after lung transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(2): 220-225, 231. doi: 10.3969/j.issn.1674-7445.2021.02.014
Citation: Chen Ao, Lian Qiaoyan, Zhang Jianheng, et al. Analysis of risk factors and clinical prognosis of acute kidney injury early after lung transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(2): 220-225, 231. doi: 10.3969/j.issn.1674-7445.2021.02.014

肺移植术后早期急性肾损伤的危险因素及预后分析

doi: 10.3969/j.issn.1674-7445.2021.02.014
基金项目: 

广东省自然科学基金 2018A030313107

详细信息
    作者简介:

    陈奥,女,硕士研究生,研究方向为肺移植术后并发症,Email:1131343416@qq.com

    通讯作者:

    巨春蓉,女,主任医师,教授,硕士研究生导师,研究方向为终末期肺疾病肺移植术前评估与术后并发症诊治,Email:juchunrong@126.com

  • 中图分类号: R617, R692

Analysis of risk factors and clinical prognosis of acute kidney injury early after lung transplantation

More Information
  • 摘要:   目的  分析肺移植术后早期急性肾损伤(AKI)的危险因素及预后。  方法  回顾性分析155例肺移植或心肺联合移植受者的临床资料,根据2012年改善全球肾脏病预后组织指南分为AKI组(104例)及非AKI组(51例)。总结肺移植术后早期AKI发生情况;收集受者的主要指标,对肺移植术后早期发生AKI的危险因素进行单因素和多因素分析;分析肺移植受者的预后情况并绘制生存曲线。  结果  肺移植术后早期AKI的发生率为67.1%(104/155),其中AKI 1期47例,AKI 2期34例,AKI 3期23例,术后早期需要连续性肾脏替代治疗(CRRT)的受者16例。术前合并糖尿病、术前合并肺动脉高压、术中平均动脉压(MAP) < 60 mmHg、术中大量输血、术后1周内他克莫司(Tac)超治疗浓度为肺移植术后早期发生AKI的独立危险因素。截止至随访终点,共66例(42.6%)受者死亡,其中AKI组50例,非AKI组16例。AKI组累积生存率低于非AKI组(40%比66%,P < 0.05),随着AKI严重程度增加,肺移植受者累积生存率降低。  结论  肺移植术后早期AKI发生率高、预后差,术前合并糖尿病、肺动脉高压,术中MAP < 60 mmHg、大量输血和术后1周内Tac超治疗浓度为肺移植术后早期发生AKI的独立危险因素。
  • 图  1  AKI 1期、AKI 2~3期及非AKI组受者住院时间和ICU入住时间的比较

    注:与非AKI组比较,aP < 0.05;与AKI 1期比较,bP < 0.05。

    Figure  1.  Comparison of hospital stay and ICU stay of recipients among AKI 1, AKI 2-3 and non-AKI group

    图  2  肺移植受者的Kaplan-Meier生存曲线

    注:A图为非AKI组受者与AKI组受者生存率比较;B图为非AKI组受者与AKI 1~3期受者生存率比较。

    Figure  2.  Kaplan-Meier survival curves of lung transplant recipients

    表  1  AKI分期标准

    Table  1.   Staging criteria of AKI

    分期 血清肌酐 尿量
    1期 48 h内上升≥0.3 mg/dL(≥26.5 μmol/L),或7 d内升至1.5~1.9倍基础值 尿量 < 0.5 mL/(kg·h),持续6~12 h
    2期 7 d内升至2.0~2.9倍基础值 尿量 < 0.5 mL/(kg·h),持续 > 12 h
    3期 48 h内上升至≥4 mg/dL(353.6 µmol/L),或7 d内升至 > 3倍基础值,或开始CRRT 尿量 < 0.3 mL/(kg·h),持续24 h或无尿12 h
    下载: 导出CSV

    表  2  肺移植术后早期AKI的危险因素分析

    Table  2.   Analysis of risk factors of AKI early after lung transplantation

    变量 单因素分析 多因素分析
    HR 95%CI P HR 95%CI P
    术前合并糖尿病 2.548 1.033~6.289 0.042 3.489 1.159~10.500 0.026
    术前合并肺动脉高压 2.367 1.091~5.134 0.029 3.311 1.291~8.492 0.013
    术前尿蛋白阳性 2.389 1.009~5.656 0.048 - - 0.546
    术前IMV支持 4.408 1.140~14.284 0.030 - - 0.635
    手术方式-单肺 参考值 - - - - 0.425
    手术方式-双肺 3.187 1.486~6.836 0.003 - - 0.821
    手术方式-心肺联合 1.205 0.280~5.575 0.770 - - 0.213
    手术时间 1.006 1.003~1.009 < 0.001 - - 0.961
    术中MAP < 60 mmHg 5.707 1.900~17.145 0.002 3.845 1.105~13.377 0.034
    术中大量输血 1.652 1.306~2.589 < 0.001 1.578 1.299~2.026 < 0.001
    术中ECMO支持 2.942 1.156~5.681 0.021 - - 0.199
    术后APACHEⅡ评分高 1.102 1.038~1.171 0.002 - - 0.174
    术后1周内Tac超治疗浓度 2.093 1.048~4.182 0.036 3.557 1.492~8.480 0.004
    注:①HR为风险比。
    CI为可信区间。
    ③-为无数据。
    ④大量输血指手术期间输血总量超过自身血容量。
    下载: 导出CSV
  • [1] VENUTA F, VAN RAEMDONCK D. History of lung transplantation[J]. J Thorac Dis, 2017, 9(12): 5458-5471. DOI: 10.21037/jtd.2017.11.84.
    [2] CHAMBERS DC, CHERIKH WS, GOLDFARB SB, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: thirty-fifth adult lung and heart-lung transplant report-2018; focus theme: multiorgan transplantation[J]. J Heart Lung Transplant, 2018, 37(10): 1169-1183. DOI: 10.1016/j.healun.2018.07.020.
    [3] LYU DM, ZAMORA MR. Medical complications of lung transplantation[J]. Proc Am Thorac Soc, 2009, 6(1): 101-107. DOI: 10.1513/pats.200808-077GO.
    [4] CHAMBERS DC, YUSEN RD, CHERIKH WS, et al. The Registry of the International Society for Heart and Lung Transplantation: thirty-fourth adult lung and heart-lung transplantation report-2017; focus theme: allograft ischemic time[J]. J Heart Lung Transplant, 2017, 36(10): 1047-1059. DOI: 10.1016/j.healun.2017.07.016.
    [5] LERTJITBANJONG P, THONGPRAYOON C, CHEUNGPASITPORN W, et al. Acute kidney injury after lung transplantation: a systematic review and Meta-analysis[J]. J Clin Med, 2019, 8(10): 1713. DOI: 10.3390/jcm8101713.
    [6] THONGPRAYOON C, LERTJITBANJONG P, HANSRIVIJIT P, et al. Acute kidney injury in patients undergoing cardiac transplantation: a Meta-analysis[J]. Medicines (Basel), 2019, 6(4): 108. DOI: 10.3390/medicines6040108.
    [7] KHWAJA A. KDIGO clinical practice guidelines for acute kidney injury[J]. Nephron Clin Pract, 2012, 120(4): c179-c184. DOI: 10.1159/000339789.
    [8] BALCI MK, VAYVADA M, SALTURK C, et al. Incidence of early acute kidney injury in lung transplant patients: a single-center experience[J]. Transplant Proc, 2017, 49(3): 593-598. DOI: 10.1016/j.transproceed.2017.01. 031.
    [9] FIDALGO P, AHMED M, MEYER SR, et al. Incidence and outcomes of acute kidney injury following orthotopic lung transplantation: a population-based cohort study[J]. Nephrol Dial Transplant, 2014, 29(9): 1702-1709. DOI: 10.1093/ndt/gfu226.
    [10] ROCHA PN, ROCHA AT, PALMER SM, et al. Acute renal failure after lung transplantation: incidence, predictors and impact on perioperative morbidity and mortality[J]. Am J Transplant, 2005, 5(6): 1469-1476. DOI: 10.1111/j.1600-6143.2005.00867.x.
    [11] WEHBE E, BROCK R, BUDEV M, et al. Short-term and long-term outcomes of acute kidney injury after lung transplantation[J]. J Heart Lung Transplant, 2012, 31(3): 244-251. DOI: 10.1016/j.healun.2011.08.016.
    [12] THOMAS JL, PHAM H, LI Y, et al. Hypoxia-inducible factor-1α activation improves renal oxygenation and mitochondrial function in early chronic kidney disease[J]. Am J Physiol Renal Physiol, 2017, 313(2): F282-F290. DOI: 10.1152/ajprenal.00579.2016.
    [13] GUPTA S, TORRES F, BOLLINENI S, et al. Left ventricular dysfunction after lung transplantation for pulmonary arterial hypertension[J]. Transplant Proc, 2015, 47(9): 2732-2736. DOI: 10.1016/j.transproceed. 2015.07.040.
    [14] TUDORACHE I, SOMMER W, KÜHN C, et al. Lung transplantation for severe pulmonary hypertension--awake extracorporeal membrane oxygenation for postoperative left ventricular remodelling[J]. Transplantation, 2015, 99(2): 451-458. DOI: 10.1097/TP.0000000000000348.
    [15] NUIS RJ, RODÉS-CABAU J, SINNING JM, et al. Blood transfusion and the risk of acute kidney injury after transcatheter aortic valve implantation[J]. Circ Cardiovasc Interv, 2012, 5(5): 680-688. DOI: 10.1161/CIRCINTERVENTIONS.112.971291.
    [16] NUIS RJ, VAN MIEGHEM NM, TZIKAS A, et al. Frequency, determinants, and prognostic effects of acute kidney injury and red blood cell transfusion in patients undergoing transcatheter aortic valve implantation[J]. Catheter Cardiovasc Interv, 2011, 77(6): 881-889. DOI: 10.1002/ccd.22874.
    [17] KINDZELSKI BA, CORCORAN P, SIEGENTHALER MP, et al. Postoperative acute kidney injury following intraoperative blood product transfusions during cardiac surgery[J]. Perfusion, 2018, 33(1): 62-70. DOI: 10.1177/0267659117712405.
    [18] BUTLER CE, DICKENS EL. Transfusion tomorrow: Royal College of Pathologists, November 2010[J]. Transfus Med, 2011, 21(4): 224-230. DOI: 10.1111/j.1365-3148.2011.01091.x.
    [19] SIKMA MA, HUNAULT CC, VAN DE GRAAF EA, et al. High tacrolimus blood concentrations early after lung transplantation and the risk of kidney injury[J]. Eur J Clin Pharmacol, 2017, 73(5): 573-580. DOI: 10.1007/s00228-017-2204-8.
    [20] MASON DP, SOLOVERA-ROZAS M, FENG J, et al. Dialysis after lung transplantation: prevalence, risk factors and outcome[J]. J Heart Lung Transplant, 2007, 26(11): 1155-1162. DOI: 10.1016/j.healun.2007.08.006.
    [21] BARRACLOUGH K, MENAHEM SA, BAILEY M, et al. Predictors of decline in renal function after lung transplantation[J]. J Heart Lung Transplant, 2006, 25(12): 1431-1435. DOI: 10.1016/j.healun.2006.09.023.
    [22] ESPOSITO C, DE MAURI A, VITULO P, et al. Risk factors for chronic renal dysfunction in lung transplant recipients[J]. Transplantation, 2007, 84(12): 1701-1703. DOI: 10.1097/01.tp.0000295989.63674.53.
    [23] ISSA N, KUKLA A, IBRAHIM HN. Calcineurin inhibitor nephrotoxicity: a review and perspective of the evidence[J]. Am J Nephrol, 2013, 37(6): 602-612. DOI: 10.1159/000351648.
    [24] BENNETT D, FOSSI A, MARCHETTI L, et al. Postoperative acute kidney injury in lung transplant recipients[J]. Interact Cardiovasc Thorac Surg, 2019, 28(6): 929-935. DOI: 10.1093/icvts/ivy355.
    [25] JACQUES F, EL-HAMAMSY I, FORTIER A, et al. Acute renal failure following lung transplantation: risk factors, mortality, and long-term consequences[J]. Eur J Cardiothorac Surg, 2012, 41(1): 193-199. DOI: 10.1016/j.ejcts.2011.04.034.
    [26] ATCHADE E, BAROUR S, TRAN-DINH A, et al. Acute kidney injury after lung transplantation: perioperative risk factors and outcome[J]. Transplant Proc, 2020, 52(3): 967-976. DOI: 10.1016/j.transproceed.2020.01.018.
  • 加载中
图(2) / 表(2)
计量
  • 文章访问数:  30
  • HTML全文浏览量:  13
  • PDF下载量:  1
  • 被引次数: 0
出版历程
  • 收稿日期:  2020-10-20
  • 网络出版日期:  2021-03-19
  • 刊出日期:  2021-03-15

目录

    /

    返回文章
    返回