Chronic kidney disease after lung transplantation: incidence, risk factors, and treatment

Abstract

Objective: The purpose of this study was to determinate the incidence of risk factors and therapeutic strategies for chronic kidney disease (CKD) among our lung transplant recipients. We also analyzed the association with 1-, 2-, and 5-years mortality after lung transplantation.

Patients and methods: This descriptive, retrospective study of 161 patients undergoing lung transplantations between June 1999 and December 2008 assessed the incidence and severity of CKD, following the updated guidelines of the National Kidney Foundation. Using univariate and multivariate analysis, we considered the impact of multiple factors on kidney function. The relationship between CDK and mortality was assessed using Kaplan-Meier method.

Results: Among 161 patients, 68.6% developed CKD. The decrease in glomerular filtration rate (GFR) was sharper in the first year. Upon, multivariate analysis, the factors most strongly associated with this decrease included advanced age (odds ratio [OR]=2.0; P<.001) and cytomegalovirus (CMV) infection (OR=2.2; P=.045). Factors significantly associated in the univariate analysis were pretransplantation GFR, pulmonary disease, initial therapy containing tacrolimus, and conversion to mycophenolate mofetil. Recipients who developed CKD at 1 year after transplantation showed a strong association with mortality (P=.001).

Conclusions: We observed a biphasic decrease in GFR, characterized by a rapid decrease in the first year. The development of CKD during this period was associated with an increased risk of death. To introduce renoprotective strategies, we must identify early predictors of decreasing renal function.