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Impact of Lung Transplantation on Renal Function in Pediatrics
Armaghan Fard-Esfahani1, Amer Shammas1, Afsaneh Amirabadi1
1Diagnostic Imaging Department, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Pediatric lung transplantation significantly impairs renal function, with most patients experiencing decreased glomerular filtration rate (GFR). Close monitoring for kidney issues and managing risks like nephrotoxic medications are crucial post-transplant.
Area of Science:
- Pediatric Nephrology
- Cardiothoracic Surgery
- Transplantation Medicine
Background:
- Lung transplantation (LTx) is vital for pediatric end-stage lung disease.
- Assessing LTx impact on renal function is key for patient outcomes.
- This study evaluates LTx effects on pediatric renal function.
Purpose of the Study:
- To analyze the impact of lung transplantation on renal function in pediatric patients.
- To identify factors contributing to renal function decline post-LTx.
- To inform management strategies for renal health in pediatric LTx recipients.
Main Methods:
- Retrospective analysis of 49 pediatric LTx recipients (age 1-204 months).
- Renal function assessed via glomerular filtration rate (GFR) and renal scans pre- and post-LTx.
- GFR decline analyzed, examining impacts of age, sex, disease, and medications.
Main Results:
- Mean GFR decreased significantly post-LTx (151.5 to 81.24 mL/min/1.73 m²).
- 72% of patients had >25% GFR decline; 40% had >50% decline.
- Impaired renal function prevalence rose from 11.6% to 65.3%; nephrotoxic agents and infections were significant risk factors.
Conclusions:
- Lung transplantation leads to significant renal function reduction in pediatric patients.
- Frequent renal assessments are recommended for early detection of impairment.
- Mitigating risks from nephrotoxic medications and infections is crucial post-LTx.
Background:
Lung transplantation (LTx) is a life-saving intervention for pediatric patients with end-stage lung diseases. Understanding its impact on renal function is essential for improving patient management and achieving the primary goals of LTx: enhancing respiratory function, quality of life, and survival. This study analyzes the effect of LTx on renal function in pediatric patients.
Methods:
This retrospective study assessed renal function in 49 children (age range: 1-204 months; median 144 months, IQR 72 months; 26 females, 23 males) who underwent LTx. Renal function was evaluated quantitatively (using glomerular filtration rate, GFR) and qualitatively (using renal scans) before and after LTx. The lowest post-LTx GFR (post-LTx LGFR) was the assessment endpoint. GFR decline was analyzed as a percentage reduction from pre- to post-LTx LGFR. The impact of age, sex, primary lung disease, and nephrotoxic medications on GFR decline was also examined.
Results:
The mean pre-LTx GFR was 151.5 mL/min/1.73 m2, while the mean post-LTx GFR was 81.24 mL/min/1.73 m2. A decrease in GFR of more than 25% was observed in 72.09% of patients, with 40.48% experiencing a reduction of more than 50%. The prevalence of impaired renal function (GFR < 90 mL/min/1.73 m2) increased from 11.63% pre-LTx to 65.31% post-LTx. Nephrotoxic agents (p = 0.006) and infections (p = 0.001) were significant risk factors.
Conclusions:
Lung transplantation significantly reduces renal function in pediatric patients. Frequent renal assessments are recommended for early detection and management of renal impairment, focusing on mitigating nephrotoxic medication and infection risks.
