SESSION TITLE: Transplantation
SESSION TYPE: Slide Presentations
PRESENTED ON: Sunday, March 23, 2014 at 12:15 PM - 01:15 PM
PURPOSE: Maintenance immunosuppression regimens to prevent lung allograft rejection include a calcineurin inhibitor (tacrolimus or cyclosporine A), which can gradually cause renal damage and impaired function, and other factors (diabetes or systemic hypertension), if present, can also contribute to progressive renal insufficiency. Lung transplant (LTX) recipients who develop profound renal dysfunction due to Stage IV kidney disease may be candidates for orthotopic kidney transplantation. We conducted a chart review to evaluate the outcomes of patients who underwent renal transplantation (RTX) for end-stage renal insufficiency associated with prior LTX to determine safety and efficacy and to identify significant complications.
METHODS: A comprehensive medical record review was performed for all lung transplant recipients who underwent LTX at the University of Wisconsin from 1988 to 2012.
RESULTS: Thirteen LTX recipients were identified who developed renal failure at our institution and underwent RTX (5 males, 8 females). Age at time of LTX ranged from 26 to 63 (mean ± SEM = 44 ± 3.6 yrs). LTX indications were cystic fibrosis (N=5), emphysema (N=7), and radiation fibrosis (N=1). Time from LTX to RTX ranged from 5 to 13 yrs (8.3 ± 0.6). Type of RTX was cadaveric (N=8), living-related (N=4), or living-unrelated (N=1). Forced expiratory volume in 1 second (FEV1) following RTX (2.20 ± 0.34 L) changed little versus pre-RTX values (2.26 ± 0.36 L); only 3 of the 13 RTX recipients had >10% decline in FEV1 following RTX, and no major complications of RTX occurred in any patient. All recipients survived beyond one year, and serum creatinine at 1 year post-RTX was 1.30 ± 0.10 mg/dL.
CONCLUSIONS: No serious complications occurred in association with RTX, and adequate renal function was sustained despite post-operative maintenance immunosuppression that included a calcineurin inhibitor in all RTX recipients.
CLINICAL IMPLICATIONS: RTX can be performed safely in lung transplant recipients and should be considered for those who develop renal failure.
DISCLOSURE: The following authors have nothing to disclose: Ted McMenomy, Mehgan Holland, Keith Meyer
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