Chronic Kidney Disease After Lung Transplantation in Spain: A Retrospective Single-Center Analysis

TL;DR

This study examines chronic kidney disease in lung transplant recipients in Spain, finding that early kidney function decline is a strong predictor of future kidney failure.

Contribution

The study identifies early post-transplant kidney function decline as a key predictor of CKD progression in lung transplant patients.

Findings

Lung transplant recipients experienced a 48% reduction in eGFR within the first few months after LTx.

Patients requiring dialysis had higher all-cause mortality compared to those who did not.

Early nephrology evaluation can uncover non-CNI causes of CKD and promote renoprotective measures.

Abstract

Objectives: Chronic kidney disease (CKD) among lung transplant (LTx) recipients has increased in recent decades. However, there is insufficient evidence regarding clinical outcomes, and current guidelines lack specific recommendations for its management. Methods: This single-center retrospective study included all patients who underwent LTx and were subsequently referred to a dedicated nephrology outpatient clinic. Major adverse renal events were defined as a composite event. Results: Eighty LTx recipients with underlying lung disease etiology such as cystic fibrosis, chronic obstructive pulmonary disease, or interstitial lung disease were included. The mean time from LTx to first nephrologist evaluation was 4.7 years with an eGFR of 31.7 mL/min/1.73 m2. LTx recipients experienced a 48% reduction in eGFR within the first few months after LTx. Rapid progressors require renal replacement therapy earlier than the slow progressors. Patients requiring dialysis had higher all-cause mortality compared to those who did not require dialysis. Conclusions: Early post-LTx functional impairment appears to be the most significant predictor for CKD progression and the eventual need for RRT. Although CNI toxicity is the most common cause of CKD, early nephrology evaluation can uncover other causes and promote early renoprotective measures. For this patient population, specific guidelines addressing CKD after LTx and a multidisciplinary approach are essential.

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