Peds Lung Transplant Carries Kidney Risk

Children who get lung transplants face a higher risk of developing chronic kidney disease. New research looks at risk assessment and prevention.

Chronic kidney disease (CKD) is a potential complication following pediatric lung transplant.

A team of researchers from Texas Children’s Hospital looked a data on 36 transplant patients to find characteristics of those patients. Reporting at the 2015 American Thoracic Society annual meeting, Maria Gazzaneo, MD, and colleagues said they had identified a high-risk population for developing CKD. They looked at the records of the 5 (13.8% of the patients) who developed CKD after the surgery.

Of the group, 80% had tacrolimus levels above 15 ng/ml during the first 7 post-operative days. These high levels of the immunosuppressive drug appear to constitute a warning that the patient is at high risk, Gazzaneo said in a study abstract presented at the 2015 American Thoracic Society annual meeting in Denver, CO.

Another sign of high risk is sustaining at least 1 episode of acute kidney injury (AKI) she said.

The children who developed CKD all had an episode of AKI, while fewer (71%) of children who did not develop CKD had an episode of AKI.

Her team now measures transplant patients' tacrolimus levels and kidney function twice daily. They also attempt to reduce the dosage of the drug as much as possible, particularly in that 7-day period.

“Children with CKD can develop many complications including hypertension, anemia, growth retardation, and bone disease,” Gazzaneo concluded, “Our study identifies a high-risk population for end-stage kidney disease, therefore targeting renoprotective strategies in earlier stages of kidney disease may decrease CKD related morbidity and mortality."

Most of the children in the study were adolescents. "If we could spare them this complication it would greatly enhance their quality of life for the rest of their lives," the authors wrote.