Short- and Long-Term Renal Outcomes Following Lung Transplantation

Overview

Evaluation of acute kidney injury, renal recovery and development of chronic kidney disease in patients undergoing lung transplantation

Full Title of Study: “Short- and Long-Term Renal Outcomes Following Lung Transplantation- A Single-Centre Experience”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Retrospective
  • Study Primary Completion Date: August 24, 2019

Detailed Description

It is well described that acute kidney injury and development of chronic kidney disease significantly impact short- and long-term survival after lung transplantation. However, there is limited data about prevalence of kidney disease according to current KDIGO consensus guidelines. It is the aim of this study to describe short- and long-term renal outcomes following lung transplantation. Selected patients who underwent prospective pretransplant renal functional reserve testing with high oral protein load will be analyzed separately in respect to occurrence of acute kidney injury following lung transplantation and development of chronic kidney disease.

Interventions

  • Other: No intervention
    • No intervention

Arms, Groups and Cohorts

  • Patients undergoing LTx
    • Retrospective analysis of clinical data
  • Patients with pretransplant renal functional reserve testing
    • Prospective analysis of clinical data

Clinical Trial Outcome Measures

Primary Measures

  • Impact of acute kidney injury (AKI) after lung transplantation on long-term renal function decline.
    • Time Frame: 7 days
    • AKI defined by KDIGO consensus criteria

Secondary Measures

  • Impact of sustained reversal versus non-recovery after AKI on long-term renal function decline after lung transplantation.
    • Time Frame: 3 years
    • AKI and CKD defined by KDIGO consensus criteria
  • Risk factors associated with development of AKI and CKD after lung transplantation
    • Time Frame: 3 years
    • AKI and CKD defined by KDIGO consensus criteria
  • Whether development of CKD is an independent risk factor for increased rejection rate and death after lung transplantation.
    • Time Frame: 3 years
    • CKD defined by KDIGO consensus criteria
  • Association between pretransplant renal functional reserve with acute kidney injury after after lung transplantation.
    • Time Frame: 7 days
    • AKI defined by KDIGO consensus criteria
  • Association between pretransplant renal functional reserve and renal function loss after lung transplantation.
    • Time Frame: 1 year
    • 24h-creatinine clearance, estimated glomerular filtration rate

Participating in This Clinical Trial

For retrospective analysis for all patients undergoing lung transplantation:

Inclusion Criteria

  • Older than 18 years

Exclusion Criteria

  • Patients with eGFR <15ml/min/1.73m2 or with chronic dialysis treatment prior LTx
  • Patients undergoing retransplantation and multiorgan transplantation

For prospective study involving patients with pretransplant renal functional reserve testing

Exclusion Criteria

  • as above
  • unable to perform renal functional reserve testing (e.g., due to critical illness)
  • pre-existing acute kidney injury

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University of Giessen
  • Provider of Information About this Clinical Study
    • Principal Investigator: Faeq Husain, Senior Physician Nephrology – University of Giessen
  • Overall Official(s)
    • Werner Seeger, MD, Study Director, University Hospital Giessen and Marburg, Giessen, Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine

References

Husain-Syed F, Ferrari F, Sharma A, Danesi TH, Bezerra P, Lopez-Giacoman S, Samoni S, de Cal M, Corradi V, Virzì GM, De Rosa S, Muciño Bermejo MJ, Estremadoyro C, Villa G, Zaragoza JJ, Caprara C, Brocca A, Birk HW, Walmrath HD, Seeger W, Nalesso F, Zanella M, Brendolan A, Giavarina D, Salvador L, Bellomo R, Rosner MH, Kellum JA, Ronco C. Preoperative Renal Functional Reserve Predicts Risk of Acute Kidney Injury After Cardiac Operation. Ann Thorac Surg. 2018 Apr;105(4):1094-1101. doi: 10.1016/j.athoracsur.2017.12.034. Epub 2018 Jan 31.

Citations Reporting on Results

Fidalgo P, Ahmed M, Meyer SR, Lien D, Weinkauf J, Cardoso FS, Jackson K, Bagshaw SM. Incidence and outcomes of acute kidney injury following orthotopic lung transplantation: a population-based cohort study. Nephrol Dial Transplant. 2014 Sep;29(9):1702-9. doi: 10.1093/ndt/gfu226. Epub 2014 Jun 23.

Fidalgo P, Ahmed M, Meyer SR, Lien D, Weinkauf J, Kapasi A, Cardoso FS, Jackson K, Bagshaw SM. Association between transient acute kidney injury and morbidity and mortality after lung transplantation: a retrospective cohort study. J Crit Care. 2014 Dec;29(6):1028-34. doi: 10.1016/j.jcrc.2014.07.024. Epub 2014 Jul 31.

Canales M, Youssef P, Spong R, Ishani A, Savik K, Hertz M, Ibrahim HN. Predictors of chronic kidney disease in long-term survivors of lung and heart-lung transplantation. Am J Transplant. 2006 Sep;6(9):2157-63. Epub 2006 Jul 6.

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