Risk of Post-Lung Transplant Renal Dysfunction in Adults With Cystic Fibrosis
Open accessAbstract
Background Cystic fibrosis (CF) is one of the leading indications for lung transplantation. The incidence and pre-lung transplant risk factors for posttransplant renal dysfunction in the CF population remain undefined.Methods We conducted a cohort study using adults (≥ 18 years old) in the CF Foundation Patient Registry from 2000 to 2008 to determine the incidence of post-lung transplant renal dysfunction, defined by an estimated glomerular filtration rate of < 60 mL/min/1.73 m(2). Multivariable Cox proportional hazards modeling was used to identify independent pretransplant risk factors for post-lung transplant renal dysfunction.Results The study cohort included 993 adult lung transplant recipients with CF, with a median follow-up of 2 years. During the study period, 311 individuals developed renal dysfunction, with a 2-year risk of 35% (95% CI, 32%-39%). Risk of posttransplant renal dysfunction increased substantially with increasing age (25 to < 35 years vs 18 to < 25 years: hazard ratio [HR], 1.60; 95% CI, 1.15-2.23; vs ≥ 35 years: HR, 2.45; 95% CI, 1.73-3.47) and female sex (HR, 1.56; 95% CI, 1.22-1.99). CF-related diabetes requiring insulin therapy (HR, 1.30; 95% CI, 1.02-1.67) and pretransplant renal function impairment (estimated glomerular filtration rate, 60-90 mL/min/m(2) vs > 90 mL/min/m(2): HR, 1.58; 95% CI, 1.19-2.12) also increased the risk of posttransplant renal dysfunction.Conclusions Renal dysfunction is common following lung transplant in the adult CF population. Increased age, female sex, CF-related diabetes requiring insulin, and pretransplant renal impairment are significant risk factors.
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The CF population may differ from the non-CF population given their young age, the impact of persistent CFTR dysfunction in other key organs like gut and liver, and their increased risk of complications such as CF-related diabetes and renal dysfunction from chronic aminoglycoside use.
“The CF population may differ from the non-CF population given their young age, the impact of persistent CF transmembrane conductance regulatory (CFTR) dysfunction in other key organs like gut and liver, and their increased risk of complications such as CF-related diabetes and renal dysfunction from chronic aminoglycoside use.10,11”
From Cystic fibrosis survival outcomes following second lung transplant: The north American experience (2023) · cites this paper as [10]
The Discussion describes CF lung transplant recipients as younger than recipients with other diagnoses and identifies CF-related diabetes as a risk factor for posttransplant renal dysfunction. It also suggests that lifetime IV aminoglycoside exposure may contribute to renal risk, but says exposure was not directly assessed. The paper does not address persistent CFTR dysfunction in the gut or liver. (LLM, conf=0.87)
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- Authors
- Quon, B. S., Mayer-Hamblett, N., Aitken, M. L., & Goss, C. H.
- Affiliations
- University of British Columbia (CA)
- Seattle Children's Hospital (US)
- University of Washington (US)
- Corresponding author
- Quon, Bradley S.
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2012-07
- Volume
- 142
- Issue
- 1
- Pages
- 185-191
- ISSN
- 0012-3692 (ISSN-L)
- PMC
- PMC3418857
- OpenAlex
- W2059555904
- Cited by
- 37
- References
- 24
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 3 · 2019: 1 · 2018: 4 · 2017: 2 · 2016: 5 · 2015: 5 · 2014: 2 · 2013: 4 · 2012: 1
- FWCI
- 3.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- CHEST Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- British Columbia Lung Association
- National Institutes of Health (DK089507)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK089507, P30DK089507)
- Topics
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cystic Fibrosis Research Advances
- Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
- Keywords
- cystic fibrosis, lung transplantation, post-transplant renal dysfunction, chronic kidney disease, estimated glomerular filtration rate, risk factors, age, sex differences, CF-related diabetes, insulin therapy, adults
- MeSH terms
- Adolescent, Adult, Age Factors, Cystic Fibrosis, Female, Follow-Up Studies, Humans, Kidney Diseases, Male, Postoperative Complications, Registries, Retrospective Studies, Risk Factors, Sex Factors, Cohort Studies, Proportional Hazards Models, Lung Transplantation, Kaplan-Meier Estimate, Young Adult
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