Improved Survival of Lung Transplant Patients With Subsequent Renal Transplant

Lung transplantation (LTx) is the definitive treatment for patients with end-stage pulmonary disease; however, the transplant process often results in variable degrees of renal dysfunction. Ultimately, some patients may require a subsequent renal transplant (RTx). A RTx as an intervention for LTx recipients with underlying kidney failure has been studied, but data about RTx to treat renal failure following LTx are limited. This study aims to explore factors that may predict the need for RTx after LTx and to analyze survival outcomes of this intervention.

The International Society for Heart and Lung Transplantation (ISHLT) Registry was utilized to compare 334 cases of RTx after LTx with 2 control groups who had (1) similarly impaired renal function (n = 1336), and (2) preserved renal function at the time of the LTx (n = 1336).

We identified variables such as recipient age, body mass index (BMI), 6-minute walking distance (6-MWD), and history of diabetes as factors to be evaluated in the context of renal function at LTx. RTx post-LTx recipients demonstrated improved survival compared with LTx-only recipients with impaired renal function but worsened survival compared with LTx-only recipients with preserved renal function at LTx.

Thus, we identify a possible role for early RTx referral as a strategy to increase survival following LTx in patients with pre-existing renal dysfunction.