Risk factors and prognostic analyses of acute kidney injury after heart transplantation
10.3760/cma.j.cn421203-20221114-00297
- VernacularTitle:心脏移植术后急性肾损伤的危险因素及预后分析
- Author:
Qiang ZHOU
1
;
Zhiming ZHOU
;
Jianchao CHEN
;
Hongling CHEN
;
Bo GENG
;
Bin YANG
Author Information
1. 新乡医学院研究生院，新乡 453003
- Keywords:
Heart transplantation;
Acute kidney injury;
Risk factors;
Prognostic analysis
- From:
Chinese Journal of Organ Transplantation
2023;44(8):479-486
- CountryChina
- Language:Chinese
-
Abstract:
Objective:This study aims to investigate the incidence, risk factors, and prognosis of acute kidney injury after heart transplantation.Methods:Clinical data of 180 recipients of heart transplantation at Zhengzhou Seventh People's Hospital from April 2018 to November 2022 are retrospectively analyzed. According to whether AKI occurred 7 days after surgery, the recipients are divided into a non AKI group(85 cases)and an AKI group(95 cases). The baseline data, general perioperative conditions, and clinical data of the two groups of recipients are compared using chi square test and rank sum test to identify possible influencing factors for AKI after heart transplantation.Determine independent risk factors through binary logistic regression.The Kaplan Meier method is used to draw survival curves to further clarify the impact of AKI on the survival and cumulative hospitalization of heart transplant recipients.Results:The incidence of postoperative AKI in 180 recipients of this study is 52.7%(95/180). Univariate analysis showed that there are statistically significant differences in recipient age, preoperative albumin, platelet count, graft cold ischemia time, and surgical time between the AKI group and the non AKI group(all P<0.05). Further multivariate analysis showes that recipient age( OR=1.021, 95% CI: 1.001~1.043, P=0.043), surgical time( OR=1.005, 95% CI: 1.001~1.008, P=0.005), platelet count( OR=0.995, 95% CI: 0.990~1.000, P=0.034), and donor cold ischemia time ( OR=0.996, 95% CI: 0.993~0.996, P=0.004)are independent risk factors for AKI after heart transplantation. Prognostic analysis showed that 35.7%(25 cases)of the AKI group received continuous renal replacement therapy(CRRT)after surgery, and 31.9%(23 cases) received aortic balloon counterpulsation(IABP)after surgery. Compared with 0 and 8.9%(7 cases)of the AKI group without AKI, the differences are statistically significant(all P<0.01). Compared with the non AKI group, the invasive mechanical ventilation time is 614 (504, 707) hours and 540 (460, 610) hours( P<0.01), the stay time in the intensive care unit is 12(8, 16)days and 10(6, 15)days( P=0.050), and the estimated glomerular filtration rate(eGFR)on the 7th day after surgery is 10(6, 15)ml/(min·1.73 m 2)and 68(57.5, 91.0)ml/(min·1.73 m 2)( P<0.01), with statistical significance. The cumulative survival rate of the AKI group after heart transplantation is lower than that of the non AKI group, and the cumulative hospitalization rate Is higher than the latter. The differences between the groups are statistically significant(all P<0.01). Conclusions:The incidence of AKI after heart transplantation is relatively high, and recipient age, platelet count, graft cold ischemia time, and surgical time are independent risk factors for AKI. Recipients with AKI after heart transplantation have a higher proportion of postoperative use of CRRT and IABP, longer invasive mechanical ventilation time and monitoring room stay time, and lower eGFR on the 7th day after surgery; at the same time, recipients with AKI after heart transplantation have a lower postoperative survival rate and a higher cumulative hospitalization rate.
