Abstract: Objective  To explore the current status and influencing factors of unplanned disconnection from continuous renal replacement therapy(CRRT) in patients after lung transplantation during treatment with extracorporeal membrane oxygenation(ECMO) combined with CRRT.  Methods  A retrospective analysis was conducted on the clinical data of 67 patients who underwent lung transplantation and received ECMO combined with CRRT treatment at Wuxi People’s Hospital from February 2018 to March 2024. Based on the criteria for unplanned CRRT disconnection, the patients were divided into the planned CRRT disconnection group and the unplanned CRRT disconnection group. After screening for potential influencing factors using univariate analysis, multivariate Logistic regression analysis was further performed to investigate the independent influencing factors of unplanned CRRT disconnection in post-lung transplant patients during ECMO combined with CRRT treatment. Results  A total of 67 post-lung transplant patients were included in this study, with a total of 211 episodes of ECMO combined with CRRT treatment. During the period, 119 episodes of unplanned CRRT disconnection occurred, with an incidence rate of 56.4%. Multivariate Logistic regression analysis showed that ECMO mode (OR=0.089, 95%CI:0.027～0.301, P＜0.001), average ECMO blood flow rate (OR=18.779, 95% CI:6.754～52.211, P＜0.001), and average CRRT ultrafiltration rate (OR=1.024, 95%CI:1.013～1.034, P＜0.001) were independent risk factors for unplanned CRRT disconnection in patients undergoing combined ECMO and CRRT therapy after lung transplantation. Conclusion During ECMO combined with CRRT therapy in patients after lung transplantation, veno-arterial ECMO (VA-ECMO) support, high ECMO blood flow rate, and excessively high CRRT ultrafiltration rate are all independent risk factors for unplanned CRRT disconnection. These findings suggest that clinical medical staff should develop refined treatment plans and proactively address equipment alarms and pipeline-related issues to reduce the incidence of unplanned CRRT disconnection, thereby improving the prognosis of patients after lung transplantation.

Key words: Lung transplantation, Extracorporeal membrane oxygenation, Renal replacement therapy, Unplanned disconnection; , Influencing factors