*Purpose: To examine the incidence of chronic kidney disease (CKD) after lung transplantation and to evaluate the recipient-related risk factors associated with the development of CKD.

*Methods: This is a single center, retrospective study including all lung transplant recipients >18y from 11/2017 to 12/2020. Multi-organ transplant recipients were excluded. AKI was defined as an increase in creatinine >0.3mg/dl from baseline.

*Results: 87 patients met our inclusion criteria. Of these, 22% received a double lung transplant, and 78% received a single lung. The most common etiologies of lung disease were idiopathic pulmonary fibrosis in 43.7%, chronic obstructive pulmonary disease in 11.5%, and non-specific interstitial pneumonitis in 11.5%. 69% of the patients were male and the mean age was 65 +/- 8.9. 28.7% were White, 17.3% were Black, 18.7% were Hispanic, and 25.3% had non-specified race/ethnicity. Common pre-transplant comorbidities included hypertension in 57.5%, diabetes in 36.8%, and cardiovascular disease 26.5%. 84 patients had CKD pre-transplant – 59.5% had CKD stage I, 31% CKD stage II and 9.5% CKD stage III. 19.5% of the patients had trace proteinuria and 3.6% had >30 protein in the UA pre transplant. 12.5% of the patients had increased renal echogenicity in US and did not develop CKD, while 9.7% of those who developed CKD had an abnormal US. 76 patients had a mean reduction in eGFR of 40.6 +/- 29 ml/min a median follow up of 597 (370-909) days post-transplant. 31 patients (38.3%) developed CKD Stage III B, 7 patients (8.6%) had CKD Stage IV and 7 patients (8.6%) had CKD Stage V &/or ESRD. 10 patients required HD post-transplant, of which 4 progressed to ESRD. 72 patients developed AKI in the first-year post-transplant. 43% of these patients developed CKD3B or grater vs 0 patients in those without AKI (p-0.001). In addition, the odds ratio for developing CKD Stage 3b or greater was 5.4 (95% CI 1.7-16.8, p-value <0.01) in individuals older than 65y vs those <65y when adjusted for age, BMI, race and sex. There was no association between obesity, history of DM, HTN, proteinuria or having received double vs single LTx with the development of CKD post-transplant.

*Conclusions: 55% of lung transplant recipients developed CKD (16% with severe CKD stage IV or worse) at a median 597 (370-909) days follow up period. The strongest risk factors for the development of CKD were age>65y at the time of transplantation and AKI in the first-year post-transplant.

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