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Abstract: PO2526

Looking Beyond the Allograft Survival: Long-Term, Five-Year Renal Outcomes in Lung Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Doraiswamy, Mohankumar, Comprehensive Transplant Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Obole, Eshetu L., Comprehensive Transplant Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Singh, Priyamvada, Comprehensive Transplant Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Pesavento, Todd E., Comprehensive Transplant Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
Background

With the increase in incidence and overall survival of lung transplant recipients, the risk for chronic sequelae in terms of CKD is on the rise. However, the data on the long-term effect on kidneys in this population is scarce. Our study is the first to assess the five-year renal outcomes in Lung transplant recipients.

Methods

We did a retrospective chart review of 171 adults with lung transplants performed between 1st January 2014 - 1st January 2019 and meeting inclusion/exclusion criteria. Primary outcomes were - the prevalence of CKD/ESRD (requiring RRT), risk of development of CKD in patients with AKI during index hospitalization, and all causes mortality in recipients with CKD when compared to the non-CKD group. Secondary outcomes were calculation of the frequency of utilization of modalities for CKD (urinalysis, renal USG, biopsy, nephrology consults).

Results

86% of patients were white, with a median age of 61 years, median BMI 27.3 kg/m2, and 60% were males. Hypertension was present in 55% of recipients at baseline. COPD and IPF were the commonest etiology for lung failure, and 66% received a double lung transplant. Baseline median creatinine and egfr were 0.8mg/dL, and 54mL/min/1.73 m2 respectively. 6% (n=171), 60% (n=161), 67% (n=153), 79% (n=47), and 86% (n=7) had CKD at baseline, 3, 6, 12, 36, 60 months, respectively. Eight percent received dialysis during the index hospitalization. The odds ratio of development of CKD in patients with an AKI episode during index hospitalization versus no AKI was 6.22 (2.87 to 13.06, p < 0.0001). Whereas, the odds ratio of all causes mortality in patients with CKD when compared to non-CKD was 3.36 (1.44 to 8.64, p-value 0.005). Hematuria and proteinuria were measured infrequently. Renal biopsy done in 1.1% with renal USG abnormal in 22%, normal in 21 % and never performed in 57%. Sixteen percent of recipients were on dialysis, 3% received a renal transplant, and 27% of mortality noted over a five-year follow up period.

Conclusion

There is a high prevalence of CKD in lung transplant recipients, and increased in the patients who had an AKI during index hospitalization. With increased lung transplant nowadays, early involvement of nephrologists is prudent to prevent and manage CKD effectively in the future. Large prospective trials to delineate the problem is warranted.