Abstract: SA-PO054
Predicting CKD in Lung Transplant Recipients
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Ahmed, Salman, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Riella, Leonardo V., Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Curhan, Gary C., Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
Background
There is a high incidence of chronic kidney disease (CKD) following lung transplantation. We examined baseline risk factors for CKD in a cohort of patients who had undergone lung transplantation.
Methods
Retrospective cohort study of 333 patients who underwent lung transplantation between January 2005 and September 2016. The follow-up period ended April 2018. Of 333 patients, we excluded: 22 underwent transplantation elsewhere; 26 had prior CKD; 8 had fewer than two outpatient serum creatinine values available; 10 died within 6 months; 2 were excluded for missing BMI data; and 17 lacked data on pre-transplant pulmonary arterial systolic pressure. The primary outcome was CKD III at up to 2 years following lung transplantation, defined by two eGFR values < 60 ml/min/1.73 m2 at least three months apart on outpatient labs.
Results
Of the 248 eligible patients, 185 developed CKD III or worse. In a multivariate logistic regression model, age (OR 1.06, per year, 95% CI 1.02-1.11) and female sex (OR 4.42, 95% CI 1.92-10.18) were associated with a higher risk of CKD III. The following pre-transplant variables were not significantly associated with increased risk of CKD: body mass index (BMI), pulmonary arterial systolic pressure (PASP), diabetes, hypertension, or etiology of lung disease. Higher pre-transplant eGFR showed a trend towards a lower risk. New onset hypertension post-transplant was not associated with CKD III.
Conclusion
Older and female patients are at higher risk for developing CKD III after lung transplantation. Future research should evaluate risk factors for additional renal outcomes, including acute kidney injury, dialysis and renal transplantation.
Multivariate adjusted odds ratios for CKD III in lung transplant patients
| Effect | Odds Ratio | 95% CI | |
| Age, y | 1.06 | 1.02 | 1.11 |
| Female | 4.42 | 1.92 | 10.18 |
| BMI, kg/m2 | 1.02 | 0.94 | 1.12 |
| Estimated GFR (eGFR), per 10 ml/min/1.73m2 | 0.84 | 0.64 | 1.00 |
| Pulmonary Artery Systolic Pressure, mmHg | 1.02 | 1.00 | 1.04 |
| Cystic Fibrosis vs other | 2.00 | 0.55 | 7.24 |
| Chronic Obstructive Pulmonary Disease vs other | 2.94 | 0.61 | 14.22 |
| Idiopatic Pulmonary Fibrosis vs other | 2.19 | 0.83 | 5.78 |
| Pre-transplant Diabetes Mellitus | 0.81 | 0.33 | 1.96 |
| Pre-transplant Hypertension | 0.95 | 0.37 | 2.45 |
| New Onset Hypertension | 1.25 | 0.54 | 2.88 |
Funding
- NIDDK Support