A small fraction of lung transplant (LTx) recipients may require kidney transplant (KTx) due to the progression of chronic kidney disease (CKD) secondary to calcineurin inhibitors (CNI). We describe factors both pre and post KTx in this select population of LTx recipients.
We conducted a retrospective review of 680 LTx recipients from Nov 1990 to Nov 2008 identifying all patients requiring KTx. Baseline demographics, co-morbidities, GFR (MDRD) at both pre LTx & post LTx, prior to KTx, obliterative bronchiolitis (BOS) at pre KTx and post KTx, as well as immunosupression utilization and survival post KTx were collected.
Out of 680 LTx patients, 29 patients (4.6%) required dialysis post LTx, out of which 8 patients (28% of dialysis dependent patients) required subsequent KTx. The median age of KTx recipients was 51 years;2 were male. The pre LTx GFR in all the patients was normal but rapidly declined as in Figure 1. The majority of patients (87.5%, n = 7) of the patients required hemodialysis, while 1 patient was on peritoneal dialysis prior to KTx. The median wait time to KTx was 68 months. 4 patients received living donor transplants, 3 recieved cadaveric transplants and 1 received deceased donor kidney transplant. Only one patient had BOS, rest had excellent graft function with no evidence of BOS at the time of KTx while 24 mths Post KTx in our group 2 patients had BOS. Kidney function improved with average GFR was 55 ml/min at 6 mths, declining to 43 ml/min at 1 yr and remained stable at 47 ml/min at 2 yrs post KTx. 6.5 years is the longest survival time post KTx in our group, patient's GFR being stable at 35 ml/min.
KTx for CNI induced CKD in LTx recipients appears to be an acceptable option for a select group of patients on renal replacement therapy.
Considerations for successful outcomes include healthy lung graft function prior to consideration for KTx, adjustment of immunosupression and surveillance of GFR post KTx.
Puneet Garcha, No Financial Disclosure Information; No Product/Research Disclosure Information