NDT Advance Access published online on August 3, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm478
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Decline in 51Cr-labelled EDTA measured glomerular filtration rate following lung transplantation
1Department of Nephrology, 2Department of Medicine B, Division of Lung Transplantation, 3Department of Nuclear Medicine and 4Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Correspondence and offprint requests to: Dr M. Hornum, Department of Nephrology 2131, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark. Email: mads.hornum{at}rh.dk
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Abstract |
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Background. The nephrotoxity of calcineurin inhibitors in lung-transplanted patients is well described, but previous studies have estimated rather than directly measured glomerular filtration rate (GFR). This study describes the decline of measured GFR in a large cohort of lung-transplanted patients from a national centre, and the correlation between measured and calculated GFR.
Methods. All lung-transplanted patients 1992–2004 (n = 390) were included in a longitudinal analysis. Seven patients were excluded due to retransplantation. Pre- and post-transplant parameters included 51Cr-labelled EDTA clearance (mGFR) and the Cockcroft–Gault calculated clearance (cGFR). Trough cyclosporine levels (C0) and demographic and transplant information were also included in the analysis.
Results. A total of 66959 C0 and serum creatinine and 1945 mGFR measurements pertaining to 383 patients were included in the analysis. Pre-transplant mGFR was significantly lower with respect to recipient age over 60 years; and patients with a referral diagnosis of pulmonary hypertension had a lower mGFR and higher baseline serum creatinine levels than patients with emphysematous disease (P < 0.05). There were linear correlations between log10 mean interval serum creatinine and log2 mGFR at all time points pre- and post-transplantation (P < 0.0001, Spearman correlation coefficient = –0.81) and between log2 cGFR and log2 mGFR (P < 0.0001, Spearman correlation coefficient = 0.81), however, the agreement between mGFR and cGFR was poor (–2.7 ± 38.6 ml/min). A simplified repeated measure ANOVA model describing post-transplant GFR over time demonstrated a 54% decline in mGFR within the first 6 months post-transplant. Pre-transplant mGFR was an important determinant of 6 month post-transplantation mGFR. Increasing mean C0, body mass index and early acute renal failure were independent risk factors for a more rapid decline in post-transplant mGFR.
Conclusion. mGFR decreases dramatically during the first 6 months after lung-transplantation. Avoidance of high dose calcineurin inhibition may postpone the onset of post-transplant end-stage renal failure.
Keywords: creatinine; cyclosporine; glomerular filtration rate; immunosuppression; lung transplantation
Received for publication: 19. 4.07
Accepted in revised form: 25. 6.07