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Updated: Jun 3, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Assessment of respiratory function in children after kidney transplantation
Marine Toubal1, Emma Allain-Launay2, Alexandra Bruel2
1Childhood Chronic Diseases Department, University Hospital of Nantes, 7 Quai Moncousu, 44093, Nantes, France. marine.toubal@chu-nantes.fr.
Insights
Pediatric kidney transplant recipients frequently develop respiratory complications. Factors like older age at transplant and basiliximab induction reduce risk, while immune deficiency and BK virus increase it, necessitating monitoring.
Area of Science:
- Pediatric Nephrology
- Pulmonology
- Transplantation Medicine
Background:
- Severe respiratory complications post-kidney transplantation are known but poorly understood in children.
- This study addresses the knowledge gap regarding respiratory disease incidence and risk factors in pediatric kidney transplant recipients.
Purpose of the Study:
- To document the prevalence and characteristics of respiratory disease in children following kidney transplantation.
- To identify clinical and demographic factors associated with respiratory complications in this vulnerable population.
Main Methods:
- Annual follow-up assessments included respiratory symptom questionnaires and pulmonary function tests (PFTs).
- Respiratory disease was defined by clinical disorders and/or abnormal PFT results.
- Multivariate analysis identified risk factors for respiratory involvement.
Main Results:
- Respiratory involvement was observed in 41% of 236 pediatric kidney transplant recipients.
- Obstructive impairment, restrictive impairment, and reduced diffusing capacity (DLCO/KCO) were noted in PFT abnormalities.
- Older age at transplantation (>3.5 years) and basiliximab induction were associated with reduced risk; immune deficiency, male gender, BK virus, and hypertension increased risk.
Conclusions:
- Pediatric kidney transplant recipients face a significant risk of respiratory complications, including irreversible lung damage.
- Systematic clinical and functional respiratory monitoring is recommended for children with respiratory symptoms, recurrent infections, or identified risk factors.
Background:
Severe respiratory complications following kidney transplantation have been reported, yet remain poorly understood in the pediatric population. This study aimed to document respiratory disease in this population.
Methods:
At annual follow-ups, patients completed a respiratory symptoms questionnaire and underwent pulmonary function tests (PFTs). We defined respiratory disease in children when they had clinical disorders and/or PFT abnormalities.
Results:
Among 236 children included, 110 (41%) exhibited respiratory involvement: 59 (53%) had only clinical disorders, 38 (35%) had only PFT abnormalities, and 13 (12%) had both. Of those with PFT abnormalities, 15 (7%) had obstructive impairment, 12 (6%) had restrictive impairment, and 30 (24%) showed decreased lung diffusion capacity for carbon monoxide (DLCO)/transfer coefficient for carbon monoxide (KCO). In the multivariate analysis, being over 3.5 years of age at the time of transplantation was associated with a reduced risk of respiratory involvement (OR 0.30, CI [0.14; 0.63], p = 0.002), such as induction with basiliximab (OR 0.39, CI [0.17; 0.90], p = 0.03). Conversely, history of immune deficiency, male gender, positive PCR for BK virus and diastolic hypertension were associated with an increased risk (OR 5.96, CI [2.15; 16.51], p = 0.0006, OR 1.97, CI [1.03; 3.77], p = 0.04, OR 3.77, CI [1.14; 12.52], p = 0.03 and OR 2.21, CI [1.13; 4.32], p = 0.02, respectively). Bronchial lesions, such as bronchiectasis, were predominantly observed on tomography.
Conclusions:
Given the risk of irreversible lung damage, we recommend systematic clinical and functional respiratory monitoring in case of respiratory symptoms, recurrent lower respiratory tract infections, and risk factors in their follow-up.
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