Impaired Renal Function Should Not Be a Barrier to Transplantation in Patients With Cystic Fibrosis

Todd C. Crawford, J. Trent Magruder, Joshua C. Grimm, Alejandro Suarez-Pierre, Xun Zhou, Jinny S. Ha, Robert S. Higgins, Stephen R. Broderick, Jonathan B. Orens, Pali Shah, Christian A. Merlo, Bo S. Kim, Errol L. Bush

Research output: Contribution to journalArticle

Abstract

Background: Previous studies have demonstrated an association between pretransplantation renal dysfunction (PRD) and increased mortality after lung transplantation (LT). The purpose of this study was to determine whether PRD impacts survival after LT in patients with cystic fibrosis (CF). Methods: We queried the United Network for Organ Sharing (UNOS) database to identify all adult (≥18 years) recipients with CF who underwent isolated LT from May 4, 2005 to December 31, 2014. We separated recipients into those with and those without PRD (glomerular filtration rate [GFR] ≤60 mL/min). We excluded patients who required dialysis before transplantation. Kaplan-Meier analysis was used to assess unadjusted survival differences. Cox proportional hazards modeling was then performed across 26 variables to assess the risk-adjusted impact of PRD on 1-, 3-, and 5-year mortality. Results: Isolated LT was performed on 1,830 patients with CF; 17 patients were excluded because of pretransplantation dialysis. Eighty-two of 1,813 patients (4.5%) had PRD (GFR ≤60 mL/min). Kaplan-Meier analysis revealed no survival differences between PRD and non-PRD groups at 1 year (85.3% versus 89.5%; log-rank p = 0.23), 3 years (71.0% versus 72.5%; p = 0.57), or 5 years (63.3% versus 59.8%; p = 0.95). After risk adjustment, PRD was not independently associated with an increased hazard for mortality at 1 year (hazard ratio [HR], 1.38 [95% confidence interval [CI], 0.74-2.58]; p = 0.31), 3 years (HR, 1.44 [95% CI, 0.92-2.24]; p = 0.11), or 5 years (HR, 1.30 [95% CI, 0.86-1.94]; p = 0.29). Conclusions: Although PRD has historically served as a relative contraindication to LT, our study is the first to suggest that among CF recipients, PRD was not associated with increased hazard for mortality out to 5 years after LT.

LanguageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - 2017

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Cystic Fibrosis
Transplantation
Lung Transplantation
Kidney
Mortality
Kaplan-Meier Estimate
Confidence Intervals
Glomerular Filtration Rate
Survival
Dialysis
Risk Adjustment
Databases

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Impaired Renal Function Should Not Be a Barrier to Transplantation in Patients With Cystic Fibrosis. / Crawford, Todd C.; Magruder, J. Trent; Grimm, Joshua C.; Suarez-Pierre, Alejandro; Zhou, Xun; Ha, Jinny S.; Higgins, Robert S.; Broderick, Stephen R.; Orens, Jonathan B.; Shah, Pali; Merlo, Christian A.; Kim, Bo S.; Bush, Errol L.

In: Annals of Thoracic Surgery, 2017.

Research output: Contribution to journalArticle

Crawford TC, Magruder JT, Grimm JC, Suarez-Pierre A, Zhou X, Ha JS et al. Impaired Renal Function Should Not Be a Barrier to Transplantation in Patients With Cystic Fibrosis. Annals of Thoracic Surgery. 2017. Available from, DOI: 10.1016/j.athoracsur.2017.05.032
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abstract = "Background: Previous studies have demonstrated an association between pretransplantation renal dysfunction (PRD) and increased mortality after lung transplantation (LT). The purpose of this study was to determine whether PRD impacts survival after LT in patients with cystic fibrosis (CF). Methods: We queried the United Network for Organ Sharing (UNOS) database to identify all adult (≥18 years) recipients with CF who underwent isolated LT from May 4, 2005 to December 31, 2014. We separated recipients into those with and those without PRD (glomerular filtration rate [GFR] ≤60 mL/min). We excluded patients who required dialysis before transplantation. Kaplan-Meier analysis was used to assess unadjusted survival differences. Cox proportional hazards modeling was then performed across 26 variables to assess the risk-adjusted impact of PRD on 1-, 3-, and 5-year mortality. Results: Isolated LT was performed on 1,830 patients with CF; 17 patients were excluded because of pretransplantation dialysis. Eighty-two of 1,813 patients (4.5\{%}) had PRD (GFR ≤60 mL/min). Kaplan-Meier analysis revealed no survival differences between PRD and non-PRD groups at 1 year (85.3\{%} versus 89.5\{%}; log-rank p = 0.23), 3 years (71.0\{%} versus 72.5\{%}; p = 0.57), or 5 years (63.3\{%} versus 59.8\{%}; p = 0.95). After risk adjustment, PRD was not independently associated with an increased hazard for mortality at 1 year (hazard ratio [HR], 1.38 [95\{%} confidence interval [CI], 0.74-2.58]; p = 0.31), 3 years (HR, 1.44 [95\{%} CI, 0.92-2.24]; p = 0.11), or 5 years (HR, 1.30 [95\{%} CI, 0.86-1.94]; p = 0.29). Conclusions: Although PRD has historically served as a relative contraindication to LT, our study is the first to suggest that among CF recipients, PRD was not associated with increased hazard for mortality out to 5 years after LT.",
author = "Crawford, {Todd C.} and Magruder, {J. Trent} and Grimm, {Joshua C.} and Alejandro Suarez-Pierre and Xun Zhou and Ha, {Jinny S.} and Higgins, {Robert S.} and Broderick, {Stephen R.} and Orens, {Jonathan B.} and Pali Shah and Merlo, {Christian A.} and Kim, {Bo S.} and Bush, {Errol L.}",
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T1 - Impaired Renal Function Should Not Be a Barrier to Transplantation in Patients With Cystic Fibrosis

AU - Crawford,Todd C.

AU - Magruder,J. Trent

AU - Grimm,Joshua C.

AU - Suarez-Pierre,Alejandro

AU - Zhou,Xun

AU - Ha,Jinny S.

AU - Higgins,Robert S.

AU - Broderick,Stephen R.

AU - Orens,Jonathan B.

AU - Shah,Pali

AU - Merlo,Christian A.

AU - Kim,Bo S.

AU - Bush,Errol L.

PY - 2017

Y1 - 2017

N2 - Background: Previous studies have demonstrated an association between pretransplantation renal dysfunction (PRD) and increased mortality after lung transplantation (LT). The purpose of this study was to determine whether PRD impacts survival after LT in patients with cystic fibrosis (CF). Methods: We queried the United Network for Organ Sharing (UNOS) database to identify all adult (≥18 years) recipients with CF who underwent isolated LT from May 4, 2005 to December 31, 2014. We separated recipients into those with and those without PRD (glomerular filtration rate [GFR] ≤60 mL/min). We excluded patients who required dialysis before transplantation. Kaplan-Meier analysis was used to assess unadjusted survival differences. Cox proportional hazards modeling was then performed across 26 variables to assess the risk-adjusted impact of PRD on 1-, 3-, and 5-year mortality. Results: Isolated LT was performed on 1,830 patients with CF; 17 patients were excluded because of pretransplantation dialysis. Eighty-two of 1,813 patients (4.5%) had PRD (GFR ≤60 mL/min). Kaplan-Meier analysis revealed no survival differences between PRD and non-PRD groups at 1 year (85.3% versus 89.5%; log-rank p = 0.23), 3 years (71.0% versus 72.5%; p = 0.57), or 5 years (63.3% versus 59.8%; p = 0.95). After risk adjustment, PRD was not independently associated with an increased hazard for mortality at 1 year (hazard ratio [HR], 1.38 [95% confidence interval [CI], 0.74-2.58]; p = 0.31), 3 years (HR, 1.44 [95% CI, 0.92-2.24]; p = 0.11), or 5 years (HR, 1.30 [95% CI, 0.86-1.94]; p = 0.29). Conclusions: Although PRD has historically served as a relative contraindication to LT, our study is the first to suggest that among CF recipients, PRD was not associated with increased hazard for mortality out to 5 years after LT.

AB - Background: Previous studies have demonstrated an association between pretransplantation renal dysfunction (PRD) and increased mortality after lung transplantation (LT). The purpose of this study was to determine whether PRD impacts survival after LT in patients with cystic fibrosis (CF). Methods: We queried the United Network for Organ Sharing (UNOS) database to identify all adult (≥18 years) recipients with CF who underwent isolated LT from May 4, 2005 to December 31, 2014. We separated recipients into those with and those without PRD (glomerular filtration rate [GFR] ≤60 mL/min). We excluded patients who required dialysis before transplantation. Kaplan-Meier analysis was used to assess unadjusted survival differences. Cox proportional hazards modeling was then performed across 26 variables to assess the risk-adjusted impact of PRD on 1-, 3-, and 5-year mortality. Results: Isolated LT was performed on 1,830 patients with CF; 17 patients were excluded because of pretransplantation dialysis. Eighty-two of 1,813 patients (4.5%) had PRD (GFR ≤60 mL/min). Kaplan-Meier analysis revealed no survival differences between PRD and non-PRD groups at 1 year (85.3% versus 89.5%; log-rank p = 0.23), 3 years (71.0% versus 72.5%; p = 0.57), or 5 years (63.3% versus 59.8%; p = 0.95). After risk adjustment, PRD was not independently associated with an increased hazard for mortality at 1 year (hazard ratio [HR], 1.38 [95% confidence interval [CI], 0.74-2.58]; p = 0.31), 3 years (HR, 1.44 [95% CI, 0.92-2.24]; p = 0.11), or 5 years (HR, 1.30 [95% CI, 0.86-1.94]; p = 0.29). Conclusions: Although PRD has historically served as a relative contraindication to LT, our study is the first to suggest that among CF recipients, PRD was not associated with increased hazard for mortality out to 5 years after LT.

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