Long-term renal outcome after lung transplantation is predicted by the 1-month postoperative renal function loss

Background. Progressive renal function loss is common after lung transplant ation. To facilitate the design of renoprotective strategies, identificatio n of early predictors for long-term renal function loss would be useful. Methods. We prospectively analyzed renal function [glomerular filtration ra te (GFR); I-125-iothalamate clearance] in a closely monitored cohort (minim um 24-month follow-up) of 57 patients who received lung transplants between November 1990 and September 1996 in our center. The analyzed end points we re the slope of the GFR from 6 months posttransplant onward and the GFR at 24 months after transplantation. Results. Before transplantation, the GFR was 100 ml/min (median, range 59-1 63). It decreased to 67 ml/ min (29-123) at 6 months, 53 ml/min (17-116) at 24 months, and 51 ml/min (20-87) at 36 months after transplantation. The m agnitude of the loss of GFR 1 month post-transplantation was the only facto r significantly correlated with absolute GFR at 24 months after transplanta tion. Pulmonary diagnosis was significantly associated with long-term rate of renal function loss. Median loss of GFR was greatest in patients with cy stic fibrosis (-10 ml/min/year, range -14 to -6 ml/min/year), preserved in pulmonary hypertension (-1 ml/min/year, range -6 to +7 ml/min/year), and in between in emphysema (-6 mi/min/year, range -27 to +12 ml/min/year). No ot her factors could be identified. Conclusions. In lung transplant recipients, the 1-month postoperative loss of GFR is an early marker for long term renal prognosis. Pulmonary diagnosi s appears to be a relevant predictor as well. These factors may guide furth er research and the development of preventive strategies.