LONG-TERM RENAL OUTCOME AFTER LUNG TRANSPLANTATION IS PREDICTED BY THE 1-MONTH POSTOPERATIVE RENAL FUNCTION LOSS

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Abstract
Progressive renal function loss is common after lung transplantation . To facilitate the design of renoprotective strategies, identification of early predictors for long-term renal function loss would be useful. We prospectively analyzed renal function [glomerular filtration rate (GFR); 125I-iothalamate clearance] in a closely monitored cohort (minimum 24-month follow-up) of 57 patients who received lung transplants between November 1990 and September 1996 in our center. The analyzed end points were the slope of the GFR from 6 months posttransplant onward and the GFR at 24 months after transplantation. Before transplantation, the GFR was 100 ml/min (median, range 59–163). It decreased to 67 ml/min (29–123) at 6 months, 53 ml/min (17–116) at 24 months, and 51 ml/min (20–87) at 36 months after transplantation. The magnitude of the loss of GFR 1 month post-transplantation was the only factor significantly correlated with absolute GFR at 24 months after transplantation. Pulmonary diagnosis was significantly associated with long-term rate of renal function loss. Median loss of GFR was greatest in patients with cystic fibrosis (−10 ml/min/year, range −14 to −6 ml/min/year), preserved in pulmonary hypertension (−1 ml/min/year, range −6 to +7 ml/min/year), and in between in emphysema (−6 ml/min/year, range −27 to +12 ml/min/year). No other factors could be identified. In lung transplant recipients, the 1-month postoperative loss of GFR is an early marker for long-term renal prognosis. Pulmonary diagnosis appears to be a relevant predictor as well. These factors may guide further research and the development of preventive strategies.