title: Combined Lung-Kidney Transplantation: An Analysis of the UNOS/OPTN Database.
abstract: Poor outcomes after thoracic transplantation with concurrent renal dysfunction are well described: without transplantation or with thoracic-only transplantation, patients face unacceptably high mortality. Outcomes after combined lung-kidney transplantation (LKT) remain largely uninvestigated. The United Network for Organ Sharing/Organ Procurement and Transplantation Network database was queried to identify all LKTs, lung transplantations (LTs), and kidney transplantations (KTs) performed in the United States from 1995 to 2013. Survival was calculated using the Kaplan-Meier method and compared using log-rank tests or Cox regression models. Thirty-one LKTs were performed. Mean recipient age was 45.4 ± 13.5 years; 48.3 per cent were male. Retransplantation for graft failure was the leading indication for LT (n = 13) and the most common renal indication was calcineurin inhibitor nephrotoxicity (n = 11). Mean lung allocation score was 46.6 ± 14.4, mean creatinine was 3.7 ± 2.8 g/dL, and glomerular filtration rate was 23.1 (interquartile range 11.9, 38.3) mL/min/1.7 m(2), and 11 (35.5%) were dialysis dependent. Patient survival after LKT was 92.9 per cent, 71.0 per cent, and 71.0 per cent at one month, six months, and one year, with a median survival of 95.2 months. One- and five-year survival after LKT, 71.0 per cent and 59.9 per cent, were similar to LT (n = 23,913), 81.7 per cent and 51.4 per cent (P = 0.061 and 0.55), and inferior to KT (n = 175,269), 94.9 per cent and 82.8 per cent (P < 0.0001), respectively. Patient survival after LKT was similar to isolated LT, and these results suggest that LKT is a feasible therapeutic option for LT candidates with significant renal dysfunction.
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Reich
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Chan
authors.forename: Lawrence S C
authors.initials: LS
authors.lastname: Czer
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.forename: Alagappan A
authors.initials: AA
authors.lastname: Annamalai
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.forename: Stanley C
authors.initials: SC
authors.lastname: Jordan
authors.forename: George
authors.initials: G
authors.lastname: Chaux
authors.forename: Danny
authors.initials: D
authors.lastname: Ramzy
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement / Q000379:methods*