Abstract: SA-OR013

Loss of Renal Function and Benefits of Measured GFR among Lung Transplant Patients

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 302 CKD: Estimating Equations, Incidence, Prevalence, Special Populations

Authors

  • Florens, Nans, Hospices Civils de Lyon, Lyon, France
  • Dubourg, Laurence, Hospices Civils de Lyon, Lyon, France
  • Senechal, Agathe, Hospices Civils de Lyon, Lyon, France
  • Philit, François, Hospices Civils de Lyon, Lyon, France
  • Juillard, Laurent, Hospices Civils de Lyon, Lyon, France
  • Lemoine, Sandrine, Hospices Civils de Lyon, Lyon, France
Background

There are about 4000 lung transplant patients over the world. Renal dysfunction and chronic kidney disease among this population are underestimated. The aim of our study was to evaluate the loss of glomerular filtration rate (GFR) after a lung transplantation.

Methods

All the lung transplant patients in the university hospital of Lyon between January 2012 and April 2016 were studied retrospectively. Patients had a pre- and/or post-transplantation measurement of their GFR (mGFR) either by the inulin gold standard method or by iohexol clearance. Estimation of the GFR was achieved with CKD-EPI equation.

Results

111 lung transplantations were performed between January 2012 and April 2016. 91 patients had a pre-transplantation mGFR. Among those patients, 13 deceased during the follow-up period, 28 had a mGFR after 1 or 2 years of their transplantation and 6 patients underwent maintenance hemodialysis after their transplantation. Mean pre-transplantation mGFR was 106 mL/min/1.73m2 and 58 mL/min/1.73m2 after transplantation (p<0.05) with a mean loss per patient of 48 mL/min/1.73m2. 6 % of the patients had a CKD stage 3 or more before the transplantation while 66% after. In pre-transplantation patients, eGFR and mGFR were significantly different (16 ± 6 mL/min/1.73m2, p<0.05) while not in post-transplantation. The risk of developing a CKD stage 3 after the transplantation was higher for patients with a pre-transplantation mGFR under 90 mL/min/1.73m2 (RR = 2,1; IC 95% 1,2 – 3,6). Patients undergoing a maintenance hemodialysis had a lower pre-transplantation mGFR than all the other patients with a post-transplantation CKD (74 ± 7 mL/min/1.73m2 vs 108 ± 5, p<0.05).

Conclusion

The prevalence of CKD among lung transplant patients is important as the loss of kidney function is about 50 mL/min/1.73m2 per patient. Lung transplant candidates with a mGFR under 90 mL/min/1.73m2 need an increased monitoring of their renal function and patients with an initial GFR< 50 mL/min/1.73m2 had to be discussed for a double-lung and kidney transplant.