Factors Related to Survival in Low-Glomerular Filtration Rate Cohorts Undergoing Lung Transplant

Background: Historically, a glomerular filtration rate (GFR) of less than 50 mL/min per 1.73 m² has been considered a contraindication to lung transplantation. Combined or sequential lung-kidney transplantation is an option for those with a GFR less than 30 mL/min per 1.73 m². Patients with a GFR of 30 to 50 mL/min per 1.73 m² are provided with no options for transplantation. This study explores factors associated with improved survival in patients who undergo isolated lung transplantation with a GFR of 30 to 50 mL/min per 1.73 m².

Methods: The United Network for Organ Sharing database was queried for adult patients undergoing primary isolated lung transplantation between January 2007 and March 2018. Regression models were used to identify factors associated with improved survival in lung recipients with a preoperative GFR of 30 to 50 mL/min per 1.73 m². The propensity score method was used to match highly performing patients (outpatient recipients aged less than 60 years) with a GFR of 30 to 50 mL/min per 1.73 m² with patients who had a GFR greater than 50 mL/min per 1.73 m². Kaplan-Meier, Cox, and logistic regression analyses compared outcomes in matched populations.

Results: A total of 21,282 lung transplantations were performed during the study period. Compared with patients with a GFR greater than 50 mL/min per 1.73 m², survival was significantly worse for patients with a GFR of 30 to 50 mL/min per 1.73 m². Multivariate analysis of patients with a GFR of 30 to 50 mL/min per 1.73 m² demonstrated outpatient status and age less than 60 years to be predictive of superior survival. After propensity matching, survival of this highly performing subset with a GFR of 30 to 50 mL/min per 1.73 m² was no different from that of patients with a normal GFR.

Conclusions: Outpatient recipients aged less than 60 years represent an optimal subset of patients with a GFR of 30 to 50 mL/min per 1.73 m². Lung transplant listing should not be declined based only on a GFR less than 50 mL/min per 1.73 m².