title: Assessment of different threshold preoperative glomerular filtration rates as markers of outcomes in lung transplantation.
abstract: BACKGROUND
  The evidence behind the widely used pre-lung transplant glomerular filtration rate (GFR) cutoff of 50 mL/min per 1.73 m2 is limited. This study reviews data from a large cohort to assess outcomes associated with this historical cutoff and to estimate other possible cutoffs that might be appropriate in lung transplantation.
  
  
  METHODS
  We conducted a retrospective cohort analysis of lung recipients at a single center. Recursive partitioning and receiver operating characteristics analysis were used to estimate other potential GFR cutoffs with 1-year mortality as the outcome. Postoperative outcomes around the various cutoffs, including survival, acute kidney injury, and dialysis, were assessed using χ2, Kaplan-Meier, and Cox regression methods.
  
  
  RESULTS
  A total of 794 lung recipients met study inclusion criteria. Compared with 778 patients with GFR 50 mL/min per 1.73 m2 or greater at time of transplant, 16 patients with GFR below this cutoff were older and more likely to have restrictive disease. One-year mortality below the cutoff was 31.3% compared with 15.1% above the cutoff (p=0.021). Recursive partitioning estimated potential GFR cutoff values between 46 and 61 mL/min per 1.73 m2. Patients with GFR below these cutoffs were at significantly higher risk for adverse outcomes (p<0.05). Receiver operating characteristics analysis was less successful at identifying meaningful cutoff values with areas under the curve approximately 0.5.
  
  
  CONCLUSIONS
  Study results support the practice of requiring candidate GFR 50 mL/min per 1.73 m2 or greater for lung transplantation. Future work should focus on reproducing the analysis in a larger cohort of patients including more individuals with low GFR.
authors.affiliation: School of Medicine, Duke University Medical Center, Durham, North Carolina. Electronic address: asishana.osho@duke.edu.
authors.forename: Asishana A
authors.initials: AA
authors.lastname: Osho
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Castleberry
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Laurie D
authors.initials: LD
authors.lastname: Snyder
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Asvin M
authors.initials: AM
authors.lastname: Ganapathi
authors.affiliation: School of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Hirji
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Mark
authors.initials: M
authors.lastname: Stafford-Smith
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Shu S
authors.initials: SS
authors.lastname: Lin
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: R Duane
authors.initials: RD
authors.lastname: Davis
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011183:Postoperative Complications; D057234:Preoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends