Long-Term Renal Outcome in Patients Bridged on ICU for Lung Transplantation

Abstract

<h3>Purpose</h3> Survival in lung transplantation (LTx) patients continues to improve. The focus of post LTx care is shifting from short term survival to long term health outcome, including LTx related comorbidities like chronic kidney disease (CKD). LTx from the intensive care unit (ICU) remains controversial. However recent data showed similar long-term overall survival and allograft function in comparison with elective LTx. Long-term renal outcome for ICU bridged LTx patients is unknown. <h3>Methods</h3> Pre- and post-LTx data from all from all LTx patients bridged on ICU bridged LTx between April 2004 and 31th of December 2018 in the University Medical Center Groningen (UMCG) were used to calculate the absolute post-LTx decline of the estimated glomerular filtration rate calculated with the CKD-EPI equation (eGFR), incidence of CKD and end-stage renal disease (ESRD). <h3>Results</h3> A total of 357 patients received a LTx, of which 41 patients were bridged on ICU. Mean follow up time was 73 months. Mean age of ICU bridged LTx patients was 47 years (18-64), and 63,4% were male. 17,1% received renal replacement therapy directly post-transplantation. Of the ICU bridged patients the mean pre-LTx eGFR was 118 ml/min per 1.73 m². Mean eGFR decline at 1 and 5 years post-LTx was 61 and 69 ml/min per 1.73 m² respectively. The cumulative incidence of CKD 3a-5 for survivors post-LTx at 1 and 5 years was 54% and 69%. The cumulative incidence of CKD 4/5 at 1 and 5 years was 7.3% and 19%. In the largest international registry for LTx (International Thoracic Organ Transplant Registry, N=>10,000) the cumulative incidence of CKD 4/5 at 1 and 5 years was 5.7% and 16.3% respectively. 5 patients developed ESRD of which 3 were treated with hemodialysis an 2 received a renal transplant. <h3>Conclusion</h3> In this single center cohort, patients bridged from ICU to LTx have impaired long-term renal outcome, comparable to ISHLT registry data from patients receiving an elective LTx. However, questions remain unanswered. To complete this analysis, data from the 316 elective transplanted patients will be collected for comparison.