Dialysis After Lung Transplantation: Prevalence, Risk Factors and Outcome

Background

Renal failure requiring dialysis after lung transplantation represents a major source of morbidity for patients and compromises their quality of life. We sought to ascertain the prevalence of dialysis after lung transplantation and to identify risk factors for its occurrence. We also assessed outcomes after institution of dialysis.

Methods

From our program’s inception in February 1990 until January 2005, 425 patients underwent lung transplantation. Data on dialysis occurrence, timing, management and outcome were extracted from the Unified Transplant Database, patient follow-up and medical record review.

Results

Thirty-seven patients developed a need for dialysis, a prevalence of 0.6%, 4%, 9%, 13%, 16% and 19%, at 30 days and 1, 3, 5, 7 and 9 years after transplant, respectively. Lower creatinine clearance (p = 0.03) and greater recipient height (p = 0.0002) increased the risk for dialysis, whereas donor blood type O (p = 0.001) and head trauma as donor cause of death (p = 0.01) lowered it. Higher doses of calcineurin inhibitors correlated with the period of highest risk for dialysis. Median survival of patients requiring dialysis was 5 months, considerably lower than expected. Four patients underwent renal transplantation, 3 of whom were still alive 3, 6 and 9 months later.

Conclusions

Dialysis after lung transplantation is common and cumulative over time. Risk factors for its development may be modifiable because they appear to be linked to nephrotoxicity secondary to immunosuppression. The low threshold for creatinine clearance appears to be 50 ml/min/1.73 m². Survival after institution of dialysis is poor, highlighting the need for prevention. Renal transplantation may be a reasonable therapeutic option.