Estimating Renal Function Following Lung Transplantation

Background: Patients undergoing lung transplantation (LTx) experience a rapid decline in glomerular filtration rate (GFR) in the acute postoperative period. However, no prospective longitudinal studies directly comparing the performance of equations for estimating GFR in this patient population currently exist. Methods: In total, 32 patients undergoing LTx met the study criteria. At pre-LTx and 1-, 3-, and 12-weeks post-LTx, GFR was determined by Cr-51-EDTA and by equations for estimating GFR based on plasma (P)-Creatinine, P-Cystatin C, or a combination of both. Results: Measured GFR declined from 98.0 mL/min/1.73 m(2) at pre-LTx to 54.1 mL/min/1.73 m(2) at 12-weeks post-LTx. Equations based on P-Creatinine underestimated GFR decline after LTx, whereas equations based on P-Cystatin C overestimated this decline. Overall, the 2021 CKD-EPI combination equation had the lowest bias and highest precision at both pre-LTx and post-LTx. Conclusions: Caution must be applied when interpreting renal function based on equations for estimating GFR in the acute postoperative period following LTx. Simplified methods for measuring GFR may allow for more widespread use of measured GFR in this vulnerable patient population.

Automated summary

Patients undergoing lung transplantation (LTx) experience a rapid decline in glomerular filtration rate (GFR) in the acute postoperative period. This study compared different equations for estimating GFR in LTx patients and found that equations based on plasma creatinine underestimated GFR decline, while equations based on plasma cystatin C overestimated GFR decline after LTx. The 2021 CKD-EPI combination equation had the most accurate estimation of GFR in both pre-LTx and post-LTx periods. Therefore, caution should be exercised when interpreting renal function based on GFR estimation equations in the acute postoperative period following LTx.