Predicting Acute Kidney Injury After Lung Transplantation: Development and Internal Validation of Perioperative Prediction Models.

IF 1.8 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2026-08-01 DOI:10.1111/ctr.70649

Shogo Trevena, Gregory I Snell, Glen P Westall, Mohammad Asghari-Jafarabadi, Mark A Shulman, Tim G Coulson

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引用次数: 0

Abstract

Background: Acute kidney injury (AKI) is common following lung transplantation (LTx), and is associated with increased morbidity and mortality. Existing renal injury risk models have not systematically evaluated perioperative variables. We aimed to develop comprehensive preoperative and early postoperative prediction models for AKI and renal replacement therapy (RRT) following LTx.

Methods: Adult LTx recipients at a single Australian tertiary center (January 2016-April 2025) were included in a retrospective cohort study. The KDIGO 2012 serum creatinine criteria were used to define AKI. Stable predictors identified via penalized regression with bootstrap resampling were incorporated into multivariable logistic regression models. Bootstrap internal validation provided optimism-adjusted performance estimates, and decision curve analysis evaluated net clinical benefit.

Results: Of 534 patients, 216 (40.4%) developed AKI, and 47 (8.8%) required RRT. The preoperative AKI model, incorporating baseline demographics, comorbidities, and laboratory variables, achieved a C-statistic of 0.632 (95%CI: 0.589-0.679). The postoperative AKI model demonstrated improved discrimination (C-statistic 0.741, 95%CI: 0.697-0.795), incorporating preoperative variables such as chronic lung allograft dysfunction as a transplant indication, alongside procedure duration and novel early postoperative predictors: P/F ratio and cumulative noradrenaline dosage. The RRT models achieved C-statistics of 0.720 (95%CI: 0.643-0.796) and 0.847 (95%CI: 0.781-0.917). Calibration slopes ranged from 0.889-0.949. Decision curve analysis demonstrated net clinical benefit over treat-all strategies across clinically relevant threshold probabilities.

Conclusions: Early postoperative models demonstrated superior discrimination and clinical utility, with timepoint-specific risk stratification capturing distinct perioperative determinants of renal injury. These models provide a foundation for external validation and targeted nephroprotective research in LTx.

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预测肺移植术后急性肾损伤：围手术期预测模型的发展和内部验证。

背景：急性肾损伤（AKI）是肺移植（LTx）后常见的，并与发病率和死亡率增加相关。现有的肾损伤风险模型尚未系统地评估围手术期变量。我们旨在建立LTx后AKI和肾替代治疗（RRT）的综合术前和术后早期预测模型。方法：在一个澳大利亚三级中心（2016年1月- 2025年4月）的成人LTx接受者纳入回顾性队列研究。使用KDIGO 2012血清肌酐标准来定义AKI。通过惩罚回归和自举重抽样确定的稳定预测因子被纳入多变量逻辑回归模型。Bootstrap内部验证提供了乐观调整后的绩效评估，决策曲线分析评估了临床净收益。结果：534例患者中，216例（40.4%）发生AKI， 47例（8.8%）需要RRT。纳入基线人口统计学、合并症和实验室变量的术前AKI模型的c统计量为0.632 （95%CI: 0.589-0.679）。术后AKI模型显示了更好的鉴别（c统计量0.741,95%CI: 0.697-0.795），将术前变量（如慢性肺移植功能障碍）作为移植指征，以及手术时间和新的术后早期预测指标：P/F比和累计去甲肾上腺素剂量。RRT模型的c统计量分别为0.720 （95%CI: 0.643-0.796）和0.847 （95%CI: 0.781-0.917）。校正斜率范围为0.889-0.949。决策曲线分析表明，在临床相关的阈值概率上，净临床效益优于全治疗策略。结论：早期术后模型具有较强的辨别力和临床实用性，特定时间点的风险分层捕获了肾损伤的不同围手术期决定因素。这些模型为LTx的外部验证和靶向性肾保护研究提供了基础。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.