Abstract:

Objective To analyze and identify the risk factors for acute kidney injury（AKI）afterhearttransplantation（HT）and to develop a predictive model for early postoperative AKI in HT recipients. Methods A retrospective analysis was conducted on clinical data of HT recipients at Zhongnan Hospital of Wuhan Universityfrom January 2021 to October 2025. Patients were divided into AKI and non-AKI groups based on whether AKI occurred within 7 days post-surgery. Lasso regression and multivariate Logistic regression were used to screen forinfluencing factors. A nomogram prediction model was established using R language. The accuracy and discriminationof the model were evaluated using the area under the receiver operating characteristic curve（AUC-ROC）and calibration curves. Results Multivariate Logistic regression analysis showed that age（OR ＝ 3.848，95% CI ＝ 1.321 ～ 11.211），preoperative mean pulmonary artery pressure（MPAP）（OR ＝ 3.775，95% CI ＝ 1.564 ～ 9.111），preoperative serum creatinine（Scr）（OR ＝ 2.027，95% CI ＝ 1.239 ～ 3.315），and postoperative central venouspressure（CVP）（OR ＝ 2.376，95% CI ＝ 1.059 ～ 5.332）were four independent risk factors for AKI after hearttransplantation. The AUC of the nomogram model was 0.910（95% CI ＝ 0.848 ～ 0.971），and the calibration curveapproximated a straight line with a slope close to 1. Conclusion The model developed in this study for predicting AKI after HT demonstrates good reliability and clinical applicability. 

Key words:

Heart Transplantation, Acute Kidney Injury, Predictive Model, Dynamic Nomogram

摘要：

目的 分析并筛选心脏移植（heart transplant，HT）受者术后发生急性肾损伤的危险因素，构建 HT 受者术后早期急性肾损伤（acute kidney injury，AKI）的预测模型。 方法 回顾性分析 2021 年1 月至 2025 年 10 月在武汉大学中南医院接受 HT 手术受者的临床资料，根据术后 7 d 内是否发生 AKI 分为 AKI 组和非 AKI 组。采用 Lasso 回归和多因素 Logistic 回归筛选影响因素，通过 R 语言建立列线图模型。使用受试者工作特征曲线下面积（AUC-ROC）、校准曲线评价模型的准确性和区分度。 结果 多因素 Logistic 回归结果显示，年龄（OR ＝ 3.848，95% CI ＝ 1.321 ～ 11.211）、术前 MPAP（OR ＝ 3.775，95% CI ＝ 1.564 ～ 9.111）、术前 Scr（OR=2.027，95%CI ＝ 1.239 ～ 3.315）、术后 CVP（OR ＝ 2.376，95% CI ＝ 1.059 ～ 5.332）是心脏移植后急性肾损伤的 4 个独立危险因素，列线图模型 AUC ＝ 0.910（95%CI ＝ 0.848 ～ 0.971），校准曲线为斜率接近 1 的斜线。 结论 本研究构建的用于预测 HT 术后 AKI 的模型具有较好的可靠性和临床适用性。

关键词:

心脏移植 , 急性肾损伤 , 预测模型 , 列线图