Transplantation: Preconditions and Outcomes in Lung Transplantation |

Impact of Pre-Transplant Kidney Function on Eary and Late Outcomes After Lung Transplantation FREE TO VIEW

Amit Banga; Manish Mohanka; Jessica Mullins; Srinivas Bollineni; Vaidehi Kaza; Fernando Torres
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University of Texas Southwestern Medical Center, Dallas, TX

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1309A. doi:10.1016/j.chest.2016.08.1425
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SESSION TITLE: Preconditions and Outcomes in Lung Transplantation

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: There is lack of data regarding the independent impact of pre-transplant kidney function on early and late survival among lung transplant (LT) recipients.

METHODS: We queried the United Network of Organ Sharing (UNOS) database for adult patients (≥ 18 years of age) undergoing LT between 1987 and 2013. We excluded patients with simultaneous dual organ transplantation and where recipient serum creatinine at the time of listing for transplantation was not available. Glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease (MDRD) Study equation for all the patients. After initial exploratory analysis, study population was split into three groups (>90, 60-90 and <60 ml/min/1.73m2) based upon the estimated GFR and survival at 1 year, 3 years and 5 years was compared using Chi-square test. In addition, survival analysis was done using different cut-offs for GFR. Once the best cut-off was identified, we adjusted for potential confounders including donor and recipient demographics, year of transplant, underlying diagnosis, recipient functional status, ventilator or ECMO support at the time of LT, and lung allocation score (where available) using multivariate logistic regression analysis (MVLR) to determine independent association with 1 year, 3 year and 5 year survival.

RESULTS: One year, 3 year and 5 year survival for the study group was 84.2% (n=17884), 67.3% (n=14347) and 55.3% (n=10898) respectively. There was a consistent decline in survival with worsening GFR as follows: mortality with 95% confidence intervals at 1 year for GFR>90ml/min/1.73m2: 14%, 13-15%; GFR 60-90ml/min/1.73m2: 17%, 16-18%; GFR<60ml/min/1.73m2: 23%, 21-26%; 3 year mortality for GFR>90ml/min/1.73m2: 31%, 30-32%; GFR 60-90ml/min/1.73m2: 34%, 32-35%; GFR<60ml/min/1.73m2: 44%, 40-47%; 5 year mortality for GFR>90ml/min/1.73m2: 43%, 42-44%; GFR 60-90ml/min/1.73m2: 45%, 44-47%; GFR<60ml/min/1.73m2: 57%, 53-60% (p<0.001 for overall comparisons). On post-hoc analysis, difference in mortality was significant between the three groups at 1 year and 3 year. However, at 5 years, survival was significantly lower only for the group with GFR <60 ml/min/1.73m2. On MVLR analysis, pre-transplant GFR with a cut-off of 75 ml/min/1.73m2 was independently associated with increased mortality at 1 year (adjusted OR, 95% CI: 1.26, 1.15-1.39; p<0.001), 3 years (adjusted OR, 95% CI: 1.29, 1.18-1.4; p<0.001) & 5 years (adjusted OR, 95% CI: 1.24, 1.13-1.36; p<0.001).

CONCLUSIONS: Mortality after LT rises in a linear fashion with progressively worse pre-transplant renal functions. A GFR>75 ml/min/1.73m2 at the time of listing is independently associated with superior 1 year, 3 year & 5 year survival.

CLINICAL IMPLICATIONS: Pre-transplant renal functions have an independent association with post-transplant survival. Given the significantly worse outcomes, transplant candidacy of patients with GFR <75 ml/min should be carefully considered.

DISCLOSURE: The following authors have nothing to disclose: Amit Banga, Manish Mohanka, Jessica Mullins, Srinivas Bollineni, Vaidehi Kaza, Fernando Torres

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