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Glomerular disease and lung transplantation
M S Paller1, B Cahill, K R Harmon
1Department of Medicine, University of Minnesota, Minneapolis 55455, USA.
Summary
Three transplant patients developed kidney disease, specifically focal segmental glomerulosclerosis, years after lung or heart/lung transplants. This rare complication highlights potential long-term risks following these procedures.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pulmonology
Background:
- Lung and heart/lung transplantation are complex procedures with potential long-term complications.
- Glomerular diseases, such as focal segmental glomerulosclerosis (FSGS), can affect kidney function post-transplant.
Observation:
- Three patients developed nephrotic-range proteinuria 2-5 years after lung or heart/lung transplants.
- Kidney biopsies revealed FSGS in two patients and probable focal sclerosis in the third.
- A review of 18 postmortem lung transplant recipients did not reveal additional glomerular disease cases.
Findings:
- The identified cases of de novo glomerular disease after lung transplantation are rare, with no prior literature reports.
- Clinical presentations varied significantly among the affected patients, lacking commonalities beyond proteinuria and transplant type.
- Underlying lung conditions and post-transplant courses, including pulmonary function and cyclosporine toxicity, differed among patients.
Implications:
- This study identifies a potential, previously unreported complication of lung and heart/lung transplantation.
- Further surveillance for glomerular disease in transplant recipients is warranted.
- The findings suggest a need to investigate the mechanisms underlying de novo FSGS post-lung transplantation.