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Original Research |

Risk of Post-Lung Transplant Renal Dysfunction in Adults With Cystic FibrosisPost-Lung Transplant Renal Dysfunction

Bradley S. Quon, MD; Nicole Mayer-Hamblett, PhD; Moira L. Aitken, MD, FCCP; Christopher H. Goss, MD
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Drs Quon, Aitken, and Goss), Department of Medicine, University of Washington, Seattle, WA; the Division of Respirology (Dr Quon), Department of Medicine, University of British Columbia, Vancouver, BC, Canada; and the Division of Pulmonary Medicine (Dr Mayer-Hamblett), Department of Pediatrics, Seattle Children’s Hospital, Seattle, WA.

Correspondence to: Bradley S. Quon, MD, University of Washington Medical Center, BB-1327, 1959 NE Pacific St, Seattle, WA 98195; e-mail: bquon@u.washington.edu

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Aitken has received travel money to attend Vertex Inc, PTC Therapeutics, Aptalis Pharma Inc, Pharmaxis Ltd, and Insmed, Inc. Investigators meetings, but none of these activities relates to the topic of this manuscript. Dr Goss has received travel money and research grant money from Insmed, Inc to attend Investigator meetings and integrate a symptom questionnaire into a clinical trial. He has also received honoraria from Hoffman-La Roche Inc and Johns Hopkins University for CME courses and course material. He has also received an honorarium donated to CF research to attend an Advisory meeting with KaloBios Pharmaceuticals, Inc. Drs Quon and Mayer-Hamblett have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Role of sponsors: The sponsors had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.

Funding/Support: This study was supported by the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases [Grant P30 DK089507-01]. Dr Quon was supported by a British Columbia Lung Association Fellowship Award.


Funding/Support: This study was supported by the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases [Grant P30 DK089507-01]. Dr Quon was supported by a British Columbia Lung Association Fellowship Award.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(1):185-191. doi:10.1378/chest.11-1926
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Background:  Cystic fibrosis (CF) is one of the leading indications for lung transplantation. The incidence and pre-lung transplant risk factors for posttransplant renal dysfunction in the CF population remain undefined.

Methods:  We conducted a cohort study using adults (≥ 18 years old) in the CF Foundation Patient Registry from 2000 to 2008 to determine the incidence of post-lung transplant renal dysfunction, defined by an estimated glomerular filtration rate of < 60 mL/min/1.73 m2. Multivariable Cox proportional hazards modeling was used to identify independent pretransplant risk factors for post-lung transplant renal dysfunction.

Results:  The study cohort included 993 adult lung transplant recipients with CF, with a median follow-up of 2 years. During the study period, 311 individuals developed renal dysfunction, with a 2-year risk of 35% (95% CI, 32%-39%). Risk of posttransplant renal dysfunction increased substantially with increasing age (25 to < 35 years vs 18 to < 25 years: hazard ratio [HR], 1.60; 95% CI, 1.15-2.23; vs ≥ 35 years: HR, 2.45; 95% CI, 1.73-3.47) and female sex (HR, 1.56; 95% CI, 1.22-1.99). CF-related diabetes requiring insulin therapy (HR, 1.30; 95% CI, 1.02-1.67) and pretransplant renal function impairment (estimated glomerular filtration rate, 60-90 mL/min/m2 vs > 90 mL/min/m2: HR, 1.58; 95% CI, 1.19-2.12) also increased the risk of posttransplant renal dysfunction.

Conclusions:  Renal dysfunction is common following lung transplant in the adult CF population. Increased age, female sex, CF-related diabetes requiring insulin, and pretransplant renal impairment are significant risk factors.

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