Incidence, Risk Factors and Outcomes of Early Acute Kidney Injury After Heart Transplantation: An 18-year Experience
Incidence, Risk Factors and Outcomes of Early Acute Kidney Injury After Heart Transplantation: An 18-year Experience
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DOI：
10.1097/tp.0000000000002293
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发表时间：
2018-11-01
期刊：
影响因子：
6.2
通讯作者：
Montejo Gonzalez, Juan Carlos
中科院分区：
文献类型：
--
作者：
Garcia-Gigorro, Renata;Renes-Carreno, Emilio;Montejo Gonzalez, Juan Carlos
背景：对于心脏移植（HT）后急性肾损伤（AKI）的发生率知之甚少，AKI是根据肾脏疾病改善全球结局分类来定义的。我们的目的是评估AKI对一组HT受体的影响。（单位：大学附属医院）方法：我们研究了1999年至2017年期间310名连续接受HT治疗的患者，AKI是根据肾脏疾病改善全球结局标准定义的。采用多变量分析分析危险因素，采用Kaplan-Meier曲线和风险校正Cox比例风险回归模型分析生存率。结果125例（40.3%）患者发生AKI，其中73例（23.5%）、18例（5.8%）和34例（11%）患者分别为AKI 1期、2期和3期。心包填塞（优势比[OR]， 16.82； 95%可信区间[CI]， 1.06-138）、急性右心衰（OR, 3.54; 95% CI, 1.82-6.88）和大出血（OR, 2.46; 95% CI, 1.18-5.1）是AKI的主要危险因素。AKI患者的住院死亡率更高（3.8% vs 16%, P < 0.05），特别是那些需要肾脏替代治疗的患者（46.9% vs 5.4%, P = 0.006）。需要肾脏替代治疗的急性肾损伤与住院死亡率独立相关（OR, 11.03; 95% CI, 4.08-29.8）。出院后中位随访时间为6.7年（四分位数间距为2.4-11.6），1年、5年和10年的总生存率分别为95.4%、85.1%和75.4%，而无AKI和AKI 2 - 3期患者的总生存率分别为85.2%、69.8%和63.5% （P = 0.08）。结论HT术后AKI的发生主要与术后并发症有关。只有严重的AKI阶段预示着更差的短期结果，这种影响似乎在长期随访中消失。
Background Little is known about the incidence of acute kidney injury (AKI), as defined using the Kidney Disease Improving Global Outcome classification, after heart transplantation (HT). Our objective was to evaluate the impact of AKI in a cohort of HT recipients. (Setting: University Hospital.)Methods We studied 310 consecutive HT recipients from 1999 to 2017, with AKI being defined according to the Kidney Disease Improving Global Outcome criteria. Risk factors were analyzed by multivariable analyses, and survival by Kaplan-Meier curves and a risk-adjusted Cox proportional hazards regression model.Results One hundred twenty-five (40.3%) patients developed AKI, with 73 (23.5%), 18 (5.8%), and 34 (11%) patients having AKI stages 1, 2, and 3, respectively. Cardiac tamponade (odds ratio [OR], 16.82; 95% confidence interval [CI], 1.06-138), acute right ventricular failure (OR, 3.54; 95% CI, 1.82-6.88), and major bleeding (OR, 2.46; 95% CI, 1.18-5.1) were the principal risk factors for AKI. Patients with AKI had a greater hospital mortality (3.8% vs 16%, P < 0.05), especially those requiring renal replacement therapy (46.9% vs 5.4%, P = 0.006). Acute kidney injury requiring renal replacement therapy was independently associated with hospital mortality (OR, 11.03; 95% CI, 4.08-29.8). With a median follow-up after hospital discharge of 6.7 years (interquartile range, 2.4-11.6), overall survival at 1, 5, and 10 years was 95.4%, 85.1%, and 75.4% versus 85.2%, 69.8% and 63.5% among patients without AKI and with AKI stages 2 to 3, respectively (P = 0.08).Conclusions The onset of AKI after HT is mainly associated with postoperative complications. Only severe AKI stage predicts worse short-term outcome, with this impact appearing to be lost at long-term follow-up.