Risk of post-lung transplant renal dysfunction in adults with cystic fibrosis.
BACKGROUND
Cystic fibrosis (CF) is one of the leading indications for lung transplantation. The incidence and pre-lung transplant risk factors for posttransplant renal dysfunction in the CF population remain undefined.


METHODS
We conducted a cohort study using adults (≥ 18 years old) in the CF Foundation Patient Registry from 2000 to 2008 to determine the incidence of post-lung transplant renal dysfunction, defined by an estimated glomerular filtration rate of < 60 mL/min/1.73 m(2). Multivariable Cox proportional hazards modeling was used to identify independent pretransplant risk factors for post-lung transplant renal dysfunction.


RESULTS
The study cohort included 993 adult lung transplant recipients with CF, with a median follow-up of 2 years. During the study period, 311 individuals developed renal dysfunction, with a 2-year risk of 35% (95% CI, 32%-39%). Risk of posttransplant renal dysfunction increased substantially with increasing age (25 to < 35 years vs 18 to < 25 years: hazard ratio [HR], 1.60; 95% CI, 1.15-2.23; vs ≥ 35 years: HR, 2.45; 95% CI, 1.73-3.47) and female sex (HR, 1.56; 95% CI, 1.22-1.99). CF-related diabetes requiring insulin therapy (HR, 1.30; 95% CI, 1.02-1.67) and pretransplant renal function impairment (estimated glomerular filtration rate, 60-90 mL/min/m(2) vs > 90 mL/min/m(2): HR, 1.58; 95% CI, 1.19-2.12) also increased the risk of posttransplant renal dysfunction.


CONCLUSIONS
Renal dysfunction is common following lung transplant in the adult CF population. Increased age, female sex, CF-related diabetes requiring insulin, and pretransplant renal impairment are significant risk factors.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA; Division of Respirology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Electronic address: bquon@u.washington.edu.
Bradley S
BS
Quon
Division of Pulmonary Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA.
Nicole
N
Mayer-Hamblett
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA.
Moira L
ML
Aitken
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA.
Christopher H
CH
Goss
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000453:epidemiology*; D016040:Lung Transplantation; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult