Analysis of risk factors and clinical prognosis of acute kidney injury early after lung transplantation
10.3969/j.issn.1674-7445.2021.02.014
- VernacularTitle:肺移植术后早期急性肾损伤的危险因素及预后分析
- Author:
Ao CHEN
1
;
Qiaoyan LIAN
;
Jianheng ZHANG
;
Xin XU
;
Bing WEI
;
Yuhang CAI
;
Danxia HUANG
;
Jianxing HE
;
Chunrong JU
Author Information
1. Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510012, China
- Publication Type:Research Article
- Keywords:
Lung transplantation;
Acute kidney injury (AKI);
Tacrolimus (Tac);
Continuous renal replacement therapy (CRRT);
Mean arterial pressure (MAP);
Serum creatinine;
Estimated glomerular filtration rate;
Intensive care unit
- From:
Organ Transplantation
2021;12(2):220-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the risk factors and clinical prognosis of acute kidney injury (AKI) early after lung transplantation. Methods Clinical data of 155 recipients undergoing lung transplantation or combined heart-lung transplantation were retrospectively analyzed, and they were divided into the AKI group (n=104) and non-AKI group (n=51) according to the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline. The incidence of AKI early after lung transplantation was summarized. The main indexes of recipients were collected. The risk factors of the occurrence of AKI early after lung transplantation were subjected to univariate and multivariate analysis. The clinical prognosis of lung transplant recipients was evaluated and the survival curve was delineated. Results The incidence of AKI early after lung transplantation was 67.1%(104/155), including 47 recipients with stage 1 AKI, 34 recipients with stage2 AKI and 23 recipients with stage 3 AKI, respectively. Sixteen recipients required continuous renal replacement therapy (CRRT) early after lung transplantation. Preoperative complication with diabetes mellitus, preoperative complication with pulmonary hypertension, intraoperative mean arterial pressure (MAP) < 60 mmHg, intraoperative massive blood transfusion, and treatment with excessive therapeutic concentration of tacrolimus (Tac) within postoperative 1 week were the independent risk factors for the occurrence of AKI early after lung transplantation. Up to the end of follow-up, 66 recipients (42.6%) died, including 50 recipients in the AKI group and 16 recipients in the non-AKI group. The cumulative survival rate in the AKI group was significantly lower than that in the non-AKI group (40% vs. 66%, P < 0.05). With the increase of AKI severity, the cumulative survival rate of lung transplant recipients was decreased. Conclusions AKI develops early after lung transplantation with high incidence and poor clinical prognosis. Preoperative complication with diabetes mellitus and pulmonary hypertension, intraoperative MAP < 60 mmHg and massive blood transfusion, and treatment with excessive therapeutic concentration of Tac within postoperative 1 week are the independent risk factors for the occurrence of AKI early after lung transplantation.
