*Purpose: The increased longevity in Lung transplant (LTx) has led to an upsurge in chronic medical comorbidities, including Acute kidney injury (AKI), Chronic kidney disease (CKD) and End stage renal disease (ESRD). Our research aims to understand the magnitude of the AKI/CKD problem in LTx recipients and its long-term implications over five years.

*Methods: We conducted a retrospective chart review of 171 adults with LTx from January 2014 to January 2019 with a follow-up of at least six months. Primary outcomes were prevalence of CKD/ESRD, AKI as a risk factor for CKD, length of stay [LOS] during index hospitalization and association of CKD with cardiovascular morbidity, and all-cause mortality.

*Results: A total of 171, 161, 153, 47, and 12 recipients formed the cohort at baseline, six, 12, 36, and 60 months, respectively. Baseline median creatinine was 0.8mg/dL, and eGFR was 90 mL/min/1.73m2. The odds of CKD development in patients with an AKI during index hospitalization versus no AKI was 6.22 [2.87 to 13.06, p-value < 0.0001]. Patients with AKI during index hospitalization had an increased length of hospital stay. The mean difference in length of stay in patients with AKI compared to no AKI was 15.8 +/- 6.6, p-value < 0.0001. The difference between mean tacrolimus trough between AKI and non-AKI was 1.064, but it was not statistically significant (p-value = 0.067). The supratherapeutic tacrolimus levels are an important cause of AKI but might not be the only etiology, and thus the results should be interpreted with caution. The eGFR drastically decreased from transplant, and 94%, 40%, 33%, 21%, and 14% had an eGFR of > 60 mL/min/1.73m2 at baseline, 6, 12, 36, and 60 months, respectively. By six months, 60% [96 out of 161] patients were labeled as CKD, which rose to 86% [10 out of 12] at 60 months. 19% required Renal replacement therapy (16% dialysis and 3% Kidney transplant) by the end of the study. The median number of dialysis treatment was five during index hospitalization but was as high as 203. The odds ratio of all causes mortality in patients with CKD compared to non-CKD was 3.36 [1.44 to 8.64, p-value = 0.005]. In our cohort, 43% of patients have a baseline history of Cardiovascular disease (CVD), and 25% developed new-onset CVD during five years of follow-up. However, there were no increased odds to develop CVD in patients based on CKD [odds ratio 1.2, p-value = 0.63]. Only 15% of CKD patients were being followed by outpatient nephrologists. The diagnostic modalities of CKD like Urinalysis, Urine protein creatinine ratio, renal biopsy, and imaging were poorly utilized.

*Conclusions: Our study is the first to evaluate the prevalence and long-term complications associated with CKD post-Lung transplant over a five-year follow-up period. Basic/translational studies to delineate the mechanism of development of CKD and large prospective trials to understand the long-term effect on Lung transplant recipients are warranted.

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