The Impact of Kidney Transplantation on Survival Outcomes for Lung Transplantation

Kidney disease requiring renal replacement therapy is common after lung transplantation and is associated with reduced survival. In 2023, the Organ Procurement and Transplantation Network implemented a safety-net policy that prioritizes kidney offers for lung transplant recipients with renal failure in the first year after transplantation. The provision is likely to increase sequential transplantation. However, the long-term survival benefit of kidney transplantation for lung transplant recipients, whether sequential or simultaneous, is not well established.

The United Network for Organ Sharing database was retrospectively analyzed for adult patients who underwent isolated lung or lung-kidney transplantation between May 2005 and December 2022. Overall survival for lung transplant recipients with kidney disease was assessed. The results were stratified by preoperative and postoperative kidney dysfunction, renal replacement therapy requirement, kidney transplant status, and kidney transplant strategy.

Among 35,038 lung transplant recipients, 526 underwent kidney transplantation. Improved survival was associated with kidney transplantation in recipients requiring postoperative renal replacement therapy (χ²= 80.7, df = 1, P < .001) and those with chronic kidney disease 3b-5 (χ²= 32.5, df = 1, P < .001). For patients with chronic kidney disease, sequential over simultaneous lung-kidney transplantation was associated with improved survival (χ²=5.1, df = 1, P < .024).

Kidney transplantation is associated with improved survival for lung transplant recipients with kidney disease. Sequential lung-kidney transplantation may offer a survival advantage over simultaneous transplantation in select patients with chronic kidney disease. These findings support the continued evaluation of kidney transplant strategies after the 2023 safety-net policy.