Assessment of different threshold preoperative glomerular filtration rates as markers of outcomes in lung transplantation
Open accessAbstract
Background The evidence behind the widely used prelung 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.
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Reduced renal function at listing is associated with increased risk, especially in candidates older than 45 years.
“Increased risk has been demonstrated in lung transplant candidates with GFR <60 mL/min/1.73m2 by chronic kidney disease epidemiology equation (CKD-EPI) at the time of listing, especially in patients > 45 years of age.(17–21)”
From Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. (2021) · cites this paper as [21]
The Comment and Results report increased posttransplant risk with low CKD-EPI GFR measured before transplantation, particularly below about 48–50 mL/min/1.73 m². The Methods say listing-time GFR was examined only in a subgroup; that analysis does not establish increased risk at listing below 60 mL/min/1.73 m² or a stronger association in patients older than 45. Page numbers were not available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIncreased risk has been demonstrated in lung transplant candidates with GFR <60 mL/min/1.73m2 at listing, especially in patients >45 years.
“Increased risk has been demonstrated in lung transplant candidates with GFR <60 mL/min/1.73m2 by chronic kidney disease epidemiology equation (CKD-EPI) at the time of listing, especially in patients > 45 years of age.(17–21)”
From Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. (2021) · cites this paper as [21]
The Methods (page unavailable) say GFR was estimated with CKD-EPI, and the Results and Comment report increased adverse outcomes at low pretransplant GFR. But the main analysis used GFR at transplantation, not listing; its mortality cutoff was about 48–50 rather than 60 mL/min/1.73 m². The Results note that low-GFR recipients were older, but do not establish a greater risk specifically in patients over 45. (LLM, conf=0.88)
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- Authors
- Osho, A. A., Castleberry, A. W., Snyder, L. D., Ganapathi, A. M., Hirji, S. A., Stafford-Smith, M., Lin, S. S., Davis, R. D., & Hartwig, M. G.
- Affiliations
- Duke University (US)
- Duke Medical Center (US)
- Corresponding author
- Osho, Asishana A.
- ORCID
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2014-07
- Volume
- 98
- Issue
- 1
- Pages
- 283-290
- ISSN
- 0003-4975 (ISSN-L)
- PMC
- PMC4332517
- OpenAlex
- W1990802861
- Semantic Scholar
- a0919be664c89acf2e54d2d08d85042ed22b492d
- Cited by
- 24
- References
- 17
- Citations by year
- 2026: 2 · 2024: 1 · 2023: 4 · 2022: 2 · 2021: 2 · 2020: 1 · 2017: 5 · 2016: 2 · 2015: 4 · 2014: 1
- FWCI
- 3.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (UM1HL088953)
- Topics
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Organ Donation and Transplantation
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Keywords
- lung transplantation, glomerular filtration rate, preoperative kidney function, transplant candidate selection, one-year mortality, acute kidney injury, dialysis, postoperative outcomes, restrictive lung disease
- MeSH terms
- Female, Follow-Up Studies, Glomerular Filtration Rate, Humans, Lung Diseases, Male, Middle Aged, North Carolina, Postoperative Complications, Prognosis, Retrospective Studies, Risk Factors, ROC Curve, Incidence, Survival Rate, Proportional Hazards Models, Lung Transplantation, Risk Assessment, Preoperative Period, Acute Kidney Injury
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