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Determining eligibility for lung transplantation: A nationwide assessment of the cutoff glomerular filtration rate.

Publication ,  Journal Article
Osho, AA; Castleberry, AW; Snyder, LD; Ganapathi, AM; Speicher, PJ; Hirji, SA; Stafford-Smith, M; Daneshmand, MA; Duane Davis, R; Hartwig, MG
Published in: J Heart Lung Transplant
April 2015

BACKGROUND: Historical concerns about lung transplantation in patients with a glomerular filtration rate (GFR) ≤ 50 ml/min/1.73 m(2) have not been validated. We hypothesize that a pre-transplant GFR ≤ 50 ml/min/1.73 m(2) represents a high mortality risk, especially in the setting of acute GFR decline. In addition, we explore the potential for improved risk stratification using a statistically derivable alternative cutoff. METHODS: Adult, primary, lung recipients in the United Network for Organ Sharing database were analyzed (October 1987 to December 2011). Recursive partitioning identified the GFR value that provides maximal separation in 1-year mortality. Survival over/under the cutoffs was compared using stratified log-rank, Cox, and Kaplan-Meier methods, before and after 1:2 propensity score matching. RESULTS: Median GFR at time of transplant for 19,425 study patients was 94.2 ml/min/1.73 m(2) (quartile 1-quartile, 2 76.9-105.9 ml/min/1.73 m(2)). Recursive partitioning identified a GFR of 40.2 ml/min/1.73 m(2) as the ideal inflection point for predicting 1-year survival. Cutoffs demonstrated statistically significant effects on survival after 840 patients with a GFR ≤ 50 ml/min/1.73 m(2) (hazard ratio, 1.28; 95% confidence interval, 1.15-1.43) and 401 patients with a GFR ≤ 40.2 ml/min/1.73 m(2) (hazard ratio, 1.57; 95% confidence interval, 1.36-1.83) were matched with high GFR controls (p < 0.001). In 13,509 patients with available GFR at the time of listing and transplant, a pre-transplant GFR decline of ≥ 50% from baseline was associated with worse survival (p < 0.001). CONCLUSIONS: A pre-transplant GFR ≤ 50 ml/min/1.73 m(2) is associated with decreased survival. However, patients with GFR between 40 and 50 ml/min/1.73 m(2) do not suffer excessive post-transplant mortality and should not be automatically excluded from listing. Notably, outcomes are worse in patients with poor renal function and concomitant pre-transplant GFR decline. Strategies should be devised to detect and manage interval renal deterioration before lung transplantation.

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Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

April 2015

Volume

34

Issue

4

Start / End Page

571 / 579

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Survival Rate
  • Surgery
  • Risk Assessment
  • Retrospective Studies
  • Patient Selection
  • Middle Aged
  • Male
  • Lung Transplantation
 

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Osho, A. A., Castleberry, A. W., Snyder, L. D., Ganapathi, A. M., Speicher, P. J., Hirji, S. A., … Hartwig, M. G. (2015). Determining eligibility for lung transplantation: A nationwide assessment of the cutoff glomerular filtration rate. J Heart Lung Transplant, 34(4), 571–579. https://doi.org/10.1016/j.healun.2014.09.035
Osho, Asishana A., Anthony W. Castleberry, Laurie D. Snyder, Asvin M. Ganapathi, Paul J. Speicher, Sameer A. Hirji, Mark Stafford-Smith, Mani A. Daneshmand, R. Duane Davis, and Matthew G. Hartwig. “Determining eligibility for lung transplantation: A nationwide assessment of the cutoff glomerular filtration rate.J Heart Lung Transplant 34, no. 4 (April 2015): 571–79. https://doi.org/10.1016/j.healun.2014.09.035.
Osho AA, Castleberry AW, Snyder LD, Ganapathi AM, Speicher PJ, Hirji SA, et al. Determining eligibility for lung transplantation: A nationwide assessment of the cutoff glomerular filtration rate. J Heart Lung Transplant. 2015 Apr;34(4):571–9.
Osho, Asishana A., et al. “Determining eligibility for lung transplantation: A nationwide assessment of the cutoff glomerular filtration rate.J Heart Lung Transplant, vol. 34, no. 4, Apr. 2015, pp. 571–79. Pubmed, doi:10.1016/j.healun.2014.09.035.
Osho AA, Castleberry AW, Snyder LD, Ganapathi AM, Speicher PJ, Hirji SA, Stafford-Smith M, Daneshmand MA, Duane Davis R, Hartwig MG. Determining eligibility for lung transplantation: A nationwide assessment of the cutoff glomerular filtration rate. J Heart Lung Transplant. 2015 Apr;34(4):571–579.
Journal cover image

Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

April 2015

Volume

34

Issue

4

Start / End Page

571 / 579

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Survival Rate
  • Surgery
  • Risk Assessment
  • Retrospective Studies
  • Patient Selection
  • Middle Aged
  • Male
  • Lung Transplantation