Pre Transplant Estimated Glomerular Filtration Rate and Other Predictors of Mortality and End Stage Kidney Disease After Lung Transplantation
1Internal Medicine, University of Vermont, Burlington, VT, 2Department of General Internal Medicine Research, University of Vermont, Burlington, VT, 3Internal Medicine, University of Iowa, Iowa City, IA
Meeting: 2021 American Transplant Congress
Abstract number: 432
Keywords: Lung transplantation, Mortality, Renal dysfunction, Renal failure
Topic: Clinical Science » Lung » Lung: All Topics
Session Information
Session Time: 7:30pm-8:30pm
Presentation Time: 7:30pm-7:40pm
Location: Virtual
*Purpose: Lung transplantation is an established treatment for end stage lung disease and as survival has improved, chronic kidney disease (CKD) has become a common complication. Prevalence of CKD has been reported at 22% at one year and about 50%-70% at five years after transplantation. Patient age, acute kidney injury, high serum tacrolimus levels, hypertension and diabetes have been associated with increased frequency of CKD post lung transplant. Aim of the present study is to determine if pre transplant CKD is a predictor of long term risk of post lung transplant mortality and end stage kidney disease (ESKD).
*Methods: We evaluated United Network of Organ Sharing (UNOS) database from 2000-2017 to include adult patients who had lung transplant, had no prior history of any transplant and were not on dialysis. We divided our cohort into four clinically relevant groups based on their estimated glomerular filtration rate (eGFR) at the time of transplant (≤44, 45-59, 60-89, ≥90ml/min/1.73m2). Our primary outcome was death and secondary outcome was ESKD. Cox regression was used to assess the effect of eGFR on mortality and cumulative incidence competing risk (CICR) (death as a competing event) method was used to see the effect of eGFR on ESKD.
*Results: We had 131, 344, 3227 and 15870 patients in groups with eGFR ≤44, 45-59, 60-89, ≥90ml/min/1.73m2 respectively. Absolute number and percent of deaths and ESKD are shown in table 1. Kaplan Meier curves for mortality and ESKD shown in figure 1 and 2 respectively. Table 2 shows the adjusted hazard ratios for mortality and ESKD in each group.
*Conclusions: Our findings shows that risk of mortality post lung transplant increases with worsening eGFR at the time of transplant. Risk of ESKD is higher for patients with eGFR between 60-89ml/min/1.73m2 as compared to patients with eGFR ≥90ml/min/1.73m2 but not for patients who had eGFR<60ml/min/1.72m2. This reflects the competing risk of high mortality in patients with eGFR <60ml/min/m2 diminishing the residual risk of ESKD.
To cite this abstract in AMA style:
Kumar A, Bonnell LN, Thomas C. Pre Transplant Estimated Glomerular Filtration Rate and Other Predictors of Mortality and End Stage Kidney Disease After Lung Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/pre-transplant-estimated-glomerular-filtration-rate-and-other-predictors-of-mortality-and-end-stage-kidney-disease-after-lung-transplantation/. Accessed May 17, 2025.« Back to 2021 American Transplant Congress