RENAL HEMODYNAMICS AFTER LUNG TRANSPLANTATION - A PROSPECTIVE-STUDY

Renal function impairment is common after solid organ transplantation, due to the nephrotoxicity of cyclosporine, Moreover, in patients with severe respiratory failure, renal function is often impaired, This re nal function impairment may predispose patients to further renal funct ion impairment after lung transplantation, Therefore, renal hemodynami cs were measured in 44 patients before lung transplantation and 1, 6, 12, 18, 24, and 30 months after transplantation. After transplantation , a decline in renal function occurred, with a progressive fall in glo merular filtration rate (GFR) of 33+/-4% at 12 months and 42+/-9% at 3 0 months, Effective renal blood flow fell by 22+/-5% at 12 months and remained stable thereafter, Changes in effective renal plasma flow (ER PF) were less pronounced than those of effective renal blood flow, due to a fall in hematocrit after transplantation. Blood pressure and ren al vascular resistance increased significantly, consistent with the ef fects of cyclosporine, Prior to transplantation, renal function impair ment with intense renal vasoconstriction had been found in a subset of the patients, Remarkably, the decrease in renal function after transp lantation was less pronounced in patients with renal function impairme nt prior to transplantation, as indicated by significant negative corr elations between pretransplantation GFR and the percentage change in G FR after transplantation, and pretransplantation ERPF and the percenta ge change in ERPF after transplantation. This suggests that the net co urse of renal hemodynamics after lung transplantation is the result of the opposed effects of cyclosporine nephrotoxicity and the favorable effects of the normalization of respiratory status, In conclusion, aft er lung transplantation a decline in renal function occurs that is les s pronounced in patients with renal function impairment and intense re nal vasoconstriction prior to transplantation. Such a renal function i mpairment, therefore, should not be considered a contraindication to l ung transplantation.