Survival Outcomes of Lung Transplant Recipients from Donors with Abnormal Kidney Function

Abstract

Aim is to assess outcomes of lung transplant recipients from donors with abnormal kidney function and to determine difference in lung utilization. We reviewed United Network for Organ Sharing (UNOS) registry for first-time adult lung transplant recipients from 06/2005 to 03/2017. Donor kidney function was divided into 3 groups based on estimated glomerular filtration rate (eGFR): >60 (Group I), 15-59 (Group II) and <15 ml/min (Group III). Recipient survival was stratified based on eGFR using Kaplan-Meier. Multivariate Cox Regression model with known risk factors that affect survival was used to compare survival among groups. In addition, we compared the difference in lung utilization in the 3 groups. Of 76,685 available donors, 52747 (68.7%) were in Group I, 20040 (26.1%) in Group II and 3898 (5%) in Group III. Lung utilization rates were: 29.7% (15670/52747), 19.4% (3879/20040), 18.1% (704/3898) for Group I, II, III, respectively. The 1, 3 and 5 year recipient survival rates were: 86.2%, 69.2% and 55.7% (Group I), 84.9%, 66.9 % and 53.8% (Group II) and 85.5%, 65.3% and 50.3% (Group III) respectively (adjusted p=0.25; multivariate cox regression method; Figure 1). When Group I was used as reference, the adjusted hazard ratio (95% confidence interval) for Group II was 1.04 (0.98-1.10) and Group III was 1.08 (0.96-1.23) after adjusting with multivariate cox regression model. Although there was no significant difference in the lung transplant recipient survival, the lung utilization from donors with abnormal kidney function was lower compared to donors with normal kidney function. Donors with abnormal kidney function can potentially be a good resource to improve the donor pool.