肺移植后的早期重大脏不良事件:慢性脏疾病的风险和预后影响
Yoshihisa Shimada1,2, Chihiro Konoeda1, Yue Cong1
1Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
General thoracic and cardiovascular surgery
|August 28, 2025
概括
肺移植后的晚期急性损伤 (AKI) 和重大不良事件 (MAKE30) 预测慢性病 (CKD) 的发展. MAKE30也会对受试者的整体存活率产生负面影响.
科学领域:
- 肝脏病学
- 心胸外科
- 移植医学
背景情况:
- 功能障碍,包括急性损伤 (AKI) 和慢性病 (CKD),在肺移植 (LT) 后具有重大挑战.
- 这些并发症与患者发病率和死亡率的增加有关,强调需要更好的理解和管理策略.
研究的目的:
- 在LT后的CKD发展背景下研究AKI的临床意义.
- 评估AKI,30天内严重脏不良事件 (MAKE30) 和长期预后,包括整体存活 (OS) 之间的关联.
主要方法:
- 对116名接受LT治疗的患者进行分析,将AKI分为早期 (E-AKI) 和晚期 (L-AKI) 阶段.
- 使用病改善全球结果 (KDIGO) 标准来定义AKI和MAKE30综合结果.
- 采用单变量和多变量分析来确定CKD预测因子,并使用卡普兰-梅尔方法进行OS分析.
主要成果:
- 发现高发病率:E-AKI为73%,L-AKI为31%,MAKE30为15%,CKD为46%.
- 多变量分析显示年龄较大和MAKE30是LT后CKD的独立预测因素.
- 一个关键的发现显示,所有患有L-AKI或MAKE30的50岁以上接受者都患有CKD;MAKE30也与减少的OS相关.
结论:
- 晚期AKI和MAKE30是肺移植后慢性瘤发展的重要因素.
- MAKE30作为预后不佳的关键指标,对LT患者的整体存活率产生负面影响.
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