Predictors of renal function following lung or heart-lung transplantation

Background. Renal failure is a common complication following non-renal solid organ transplantation. The purpose of our study was to define the rate of decline in renal function and to identify independent risk factors associated with renal failure following lung or heart-lung transplantation. Methods. Between May 1986 and December 1998, 219 patients underwent lung or heart-lung transplantation at the University of Minnesota and survived at least six months (33 heart-lung, 66 bilateral single lung, and 120 unilateral single lung transplants). The mean age at the time of transplant was 45.9 +/- 11.6 years (mean +/- SD; range, 15 to 65 years), and the mean pre-transplant serum creatinine level was 0.88 +/- 0.19 mg/dL. All patients were treated with a calcineurin inhibitor (164 cyclosporine, 55 tacrolimus). Results. During the follow-up period (median 44 months, range 6.8 to 163 months), 16 patients (7.3%) developed end-stage renal disease. The cumulative incidence of doubling of serum creatinine was 34% at one year, 43% at two years and 53% by five years. Factors associated with the primary end point of the time to doubling of the baseline serum creatinine by proportional hazards regression were cumulative periods with diastolic blood pressure greater than 90 mm Hg [relative risk (RR) 1.30, P = 0.02] and the serum creatinine value at one month post-transplantation (RR 1.28, P = 0.03). Use of tacrolimus during the first six months after transplantation was associated with a significant decrease in the risk for time to doubling of serum creatinine (RR 0.38, P = 0.009) and a lower rate of acute rejection. Conclusions. These results suggest that potential renoprotective strategies following lung or heart-lung transplantation include avoidance of peri-transplant renal injury, diligent blood pressure control, and preferential use of tacrolimus over cyclosporine.