Incidence of Kidney Failure after Primary Organ Transplant.

Abstract

Careful selection of multiorgan transplant candidates is required to avoid unintended consequences to patients waiting for kidney transplant alone. The need for a safety net among heart and lung transplant recipients is unknown. The objective of this study was to quantify the incidence of kidney failure after liver, heart, or lung transplantation and identify pre-transplant predictors of post-transplant kidney failure. A retrospective cross-sectional study of adults who received liver, heart, or lung transplant between January 1, 2008 and December 31, 2018 was conducted using data from the Scientific Registry of Transplant Recipient and the United States Renal Data System. Post-transplant renal failure was defined as (a) new start of dialysis; (b) estimated glomerular filtration rate of < 25 mL/min; (c) a new waitlisting for a kidney transplant; or (d) receipt of a kidney transplant. The final descriptive cohort 53,620 liver transplant recipients, 22,042 heart transplant recipients, and 10,688 lung transplant recipients. In the first-year post-transplant, the probability of ESKD was comparable among heart transplant recipients (0.036, 95% CI [0.033, 0.038]) and liver transplant recipients (0.033, 95% CI [0.031, 0.035]) but was markedly lower in lung transplant recipients (0.024, 95% CI [0.021, 0.027]). In the second-year post-transplant, the probability of ESKD was comparable among liver (0.016, 95% CI [0.015, 0.017]), lung (0.018, 95% CI [0.015, 0.021]), and heart transplant recipients (0.014, 95% CI [0.013, 0.016]). Candidates for thoracic transplant would likely benefit from a safety net policy similar to the one enacted in 2017 for liver transplant, so as to maintain judicious patient selection for simultaneous multi-organ transplant. National data sources do not currently collect sufficiently reliable follow up data to identify pre-transplant predictors of end stage kidney disease, pointing to a need for transplant centers to consistently report kidney impairment data to national databases.