GENERAL THORACIC
1038
OTANI ET AL KIDNEY TRANSPLANTATION AFTER LUNG/HEART-LUNG TRANSPLANTATION
5. Coopersmith CM, Brennan DC, Miller B, et al. Renal transplantation following previous heart, liver, and lung transplantation: an 8-year single-center experience. Surgery 2001;130:457–62. 6. Ishani A, Erturk S, Hertz MI, Matas AJ, Savik K, Rosenberg ME. Predictors of renal function following lung or heart-lung transplantation. Kidney Int 2002;61:2228–34. 7. Jayasena SD, Riaz A, Lewis CM, Neild GH, Thompson FD, Woolfson RG. Outcome in patients with end-stage renal disease following heart or heart-lung transplantation receiving peritoneal dialysis. Nephrol Dial Transplant 2001;16:1681–5. 8. Lonze BE, Warren DS, Stewart ZA, et al. Kidney transplantation in previous heart or lung recipients. Am J Transplant 2009;9:578–85. 9. Mason DP, Solovera-Rozas M, Feng J, et al. Dialysis after lung transplantation: prevalence, risk factors and outcome. J Heart Lung Transplant 2007;26:1155–62. 10. Rosenberger C, Stein J, Jurgensen JS, et al. Risk stratification for renal transplantation after cardiac or lung transplantation: single-center experience and review of the literature. Kidney Blood Press Res 2007;30:260–6. 11. Srinivas TR, Stephany BR, Budev M, et al. An emerging population: kidney transplant candidates who are placed on the waiting list after liver, heart, and lung transplantation. Clin J Am Soc Nephrol 2010;5:1881–6. 12. Tarnow H, Herlenius G, Friman S, et al. Outcome of renal transplantation subsequent to liver, heart, or lung transplantation. Transplant Proc 2006;38:2649–50. 13. Wolf JH, Sulewski ME, Cassuto JR, et al. Simultaneous thoracic and abdominal transplantation: can we justify two organs for one recipient? Am J Transplant 2013;13:1806–16. 14. Esmore DS, Brown R, Buckland M, et al. Techniques and results in bilateral sequential single lung transplantation: the National Heart & Lung Replacement Service. J Card Surg 1994;9:1–14. 15. Snell GI, Westall GP, Paraskeva MA. Immunosuppression and allograft rejection following lung transplantation: evidence to date. Drugs 2013;73:1793–813. 16. Paraskeva M, McLean C, Ellis S, et al. Acute fibrinoid organizing pneumonia after lung transplantation. Am J Respir Crit Care Med 2013;187:1360–8. 17. Robinson PD, Shroff RC, Spencer H. Renal complications following lung and heart-lung transplantation. Pediatr Nephrol 2013;28:375–86. 18. Osho AA, Castleberry AW, Snyder LD, et al. Assessment of different threshold preoperative glomerular filtration rates as markers of outcomes in lung transplantation. Ann Thorac Surg 2014;98:283–9; discussion 289–90. 19. Orens JB, Estenne M, Arcasoy S, et al. International guidelines for the selection of lung transplant candidates: 2006 update—a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2006;25:745–55. 20. Meier-Kriesche HU, Kaplan B. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant
21.
22. 23. 24. 25. 26. 27. 28.
29. 30. 31.
32. 33.
34.
35.
36.
Ann Thorac Surg 2015;99:1032–9
outcomes: a paired donor kidney analysis. Transplantation 2002;74:1377–81. Mange KC, Joffe MM, Feldman HI. Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors. N Engl J Med 2001;344: 726–31. Meier-Kriesche HU, Port FK, Ojo AO, et al. Effect of waiting time on renal transplant outcome. Kidney Int 2000;58:1311–7. Subramanian V, Ramachandran S, Klein C, et al. ABOincompatible organ transplantation. Int J Immunogenet 2012;39:282–90. Segev DL, Muzaale AD, Caffo BS, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA 2010;303:959–66. Greco F, Hoda MR, Alcaraz A, Bachmann A, Hakenberg OW, Fornara P. Laparoscopic living-donor nephrectomy: analysis of the existing literature. Eur Urol 2010;58:498–509. Ibrahim HN, Foley R, Tan L, et al. Long-term consequences of kidney donation. N Engl J Med 2009;360:459–69. Blanche C, Kamlot A, Blanche DA, et al. Combined heartkidney transplantation with single-donor allografts. J Thorac Cardiovasc Surg 2001;122:495–500. Pinderski LJ, Kirklin JK, McGiffin D, et al. Multi-organ transplantation: is there a protective effect against acute and chronic rejection? J Heart Lung Transplant 2005;24: 1828–33. Rana A, Robles S, Russo MJ, et al. The combined organ effect: protection against rejection? Ann Surg 2008;248:871–9. Sarris GE, Smith JA, Shumway NE, et al. Long-term results of combined heart-lung transplantation: the Stanford experience. J Heart Lung Transplant 1994;13:940–9. Vricella LA, Karamichalis JM, Ahmad S, Robbins RC, Whyte RI, Reitz BA. Lung and heart-lung transplantation in patients with end-stage cystic fibrosis: the Stanford experience. Ann Thorac Surg 2002;74:13–7; discussion 17–8. Bush A, Gabriel R. Pulmonary function in chronic renal failure: effects of dialysis and transplantation. Thorax 1991;46:424–8. Chan CH, Lai CK, Li PK, Leung CB, Ho AS, Lai KN. Effect of renal transplantation on pulmonary function in patients with end-stage renal failure. Am J Nephrol 1996;16:144–8. Ewert R, Opitz C, Wensel R, Dandel M, Mutze S, Reinke P. Abnormalities of pulmonary diffusion capacity in long-term survivors after kidney transplantation. Chest 2002;122: 639–44. Guleria S, Agarwal RK, Guleria R, Bhowmik D, Agarwal SK, Tiwari SC. The effect of renal transplantation on pulmonary function and respiratory muscle strength in patients with end-stage renal disease. Transplant Proc 2005;37:664–5. Karacan O, Tutal E, Colak T, Sezer S, Eyuboglu FO, Haberal M. Pulmonary function in renal transplant recipients and end-stage renal disease patients undergoing maintenance dialysis. Transplant Proc 2006;38: 396–400.
INVITED COMMENTARY Traditionally, renal failure in the setting of lung transplantation has been an ominous condition associated with poor survival. This is due to the exquisite sensitivity of the transplanted lung to shifts in volume status. Fluid retention associated with renal impairment is poorly tolerated in the lung allograft due to inability of the denervated graft to autoregulate blood flow and the lack of a functional lymphatic system within the transplanted lung to
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
remove excess alveolar fluid. These factors, combined with further postoperative immunosuppressive drug toxicity to the kidney days to months after lung transplantation, may necessitate some patients to undergo dialysis. Both peritoneal and hemodialysis have been shown to be poorly tolerated in lung transplant recipients [1]. For these reasons, most experienced transplant surgeons avoid performing lung transplants in patients who
0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2015.01.002
Ann Thorac Surg 2015;99:1032–9
OTANI ET AL KIDNEY TRANSPLANTATION AFTER LUNG/HEART-LUNG TRANSPLANTATION
This is one of the first papers to encourage centers to accept select patients for lung transplantation who have significant renal impairment and to provide hope to those individuals who develop end-stage renal failure after lung transplant. The frontiers of our specialty are being redefined and will continue to be refined as other centers report their experiences with similar groups of patients. Patricia A. Thistlethwaite, MD, PhD Division of Cardiothoracic Surgery University of California, San Diego 9300 Campus Point Dr La Jolla, CA 92037-7892 e-mail: [email protected]
References 1. Hennessy SA, Gillen JR, Hranjec T, et al. Influence of hemodialysis on clinical outcomes after lung transplantation. J Surg Res 2013;183:916–21. 2. Osho AA, Castleberry AW, Snyder LD, et al. Assessment of different threshold preoperative glomerular filtration rates as markers of outcomes in lung transplantation. Ann Thorac Surg 2014;98:283–9. 3. Otani S, Levvey BJ, Westall GP, et al. Long-term successful outcomes from kidney transplantation after lung and heartlung transplantation. Ann Thorac Surg 2015;99:1032–9. 4. OPTN/SRTR 2012 Annual Data Report: Kidney. Available at srtr. transplant.hrsa.gov/annual_reports/2012/pdf/01_kidney_13.pdf. Accessed February 2, 2015.
GENERAL THORACIC
have no expectation of renal recovery after lung transplant and whose glomerular filtration rate is less than 50 mL/minute per 1.73 m2 [2]. Clearly, a better approach is needed for this difficult group of patients. The paper by Otani and colleagues [3] takes a retrospective look at a single institution’s experience with combined lung–kidney transplantation as well as kidney transplantation months after lung transplantation. It is one of few papers to describe simultaneous lung–kidney transplantation in the medical literature. Although the numbers are small, they debunk the myths that, (1) simultaneous lung–kidney transplant should be avoided due to worse outcomes compared with lung transplant patients alone, and (2) kidney transplant for chronic renal failure after lung transplantation is associated with unacceptable long-term survival. The “take home” message of this paper is that patients with renal failure months after lung transplant are best managed by avoiding dialysis with preemptive kidney transplant or by minimizing dialysis time prior to kidney transplant. Because the average wait time for a kidney from a deceased donor in the United States is approximately 5 years [4], sequential lung–kidney transplant utilizing a cadaveric kidney after a long dialysis time is not an attractive option. Rather, identification and use of a living-related kidney donor appears crucial for limiting morbidity and mortality in the lung transplant patient who develops end-stage renal failure after transplant.
1039
1038
OTANI ET AL KIDNEY TRANSPLANTATION AFTER LUNG/HEART-LUNG TRANSPLANTATION
5. Coopersmith CM, Brennan DC, Miller B, et al. Renal transplantation following previous heart, liver, and lung transplantation: an 8-year single-center experience. Surgery 2001;130:457–62. 6. Ishani A, Erturk S, Hertz MI, Matas AJ, Savik K, Rosenberg ME. Predictors of renal function following lung or heart-lung transplantation. Kidney Int 2002;61:2228–34. 7. Jayasena SD, Riaz A, Lewis CM, Neild GH, Thompson FD, Woolfson RG. Outcome in patients with end-stage renal disease following heart or heart-lung transplantation receiving peritoneal dialysis. Nephrol Dial Transplant 2001;16:1681–5. 8. Lonze BE, Warren DS, Stewart ZA, et al. Kidney transplantation in previous heart or lung recipients. Am J Transplant 2009;9:578–85. 9. Mason DP, Solovera-Rozas M, Feng J, et al. Dialysis after lung transplantation: prevalence, risk factors and outcome. J Heart Lung Transplant 2007;26:1155–62. 10. Rosenberger C, Stein J, Jurgensen JS, et al. Risk stratification for renal transplantation after cardiac or lung transplantation: single-center experience and review of the literature. Kidney Blood Press Res 2007;30:260–6. 11. Srinivas TR, Stephany BR, Budev M, et al. An emerging population: kidney transplant candidates who are placed on the waiting list after liver, heart, and lung transplantation. Clin J Am Soc Nephrol 2010;5:1881–6. 12. Tarnow H, Herlenius G, Friman S, et al. Outcome of renal transplantation subsequent to liver, heart, or lung transplantation. Transplant Proc 2006;38:2649–50. 13. Wolf JH, Sulewski ME, Cassuto JR, et al. Simultaneous thoracic and abdominal transplantation: can we justify two organs for one recipient? Am J Transplant 2013;13:1806–16. 14. Esmore DS, Brown R, Buckland M, et al. Techniques and results in bilateral sequential single lung transplantation: the National Heart & Lung Replacement Service. J Card Surg 1994;9:1–14. 15. Snell GI, Westall GP, Paraskeva MA. Immunosuppression and allograft rejection following lung transplantation: evidence to date. Drugs 2013;73:1793–813. 16. Paraskeva M, McLean C, Ellis S, et al. Acute fibrinoid organizing pneumonia after lung transplantation. Am J Respir Crit Care Med 2013;187:1360–8. 17. Robinson PD, Shroff RC, Spencer H. Renal complications following lung and heart-lung transplantation. Pediatr Nephrol 2013;28:375–86. 18. Osho AA, Castleberry AW, Snyder LD, et al. Assessment of different threshold preoperative glomerular filtration rates as markers of outcomes in lung transplantation. Ann Thorac Surg 2014;98:283–9; discussion 289–90. 19. Orens JB, Estenne M, Arcasoy S, et al. International guidelines for the selection of lung transplant candidates: 2006 update—a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2006;25:745–55. 20. Meier-Kriesche HU, Kaplan B. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant
21.
22. 23. 24. 25. 26. 27. 28.
29. 30. 31.
32. 33.
34.
35.
36.
Ann Thorac Surg 2015;99:1032–9
outcomes: a paired donor kidney analysis. Transplantation 2002;74:1377–81. Mange KC, Joffe MM, Feldman HI. Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors. N Engl J Med 2001;344: 726–31. Meier-Kriesche HU, Port FK, Ojo AO, et al. Effect of waiting time on renal transplant outcome. Kidney Int 2000;58:1311–7. Subramanian V, Ramachandran S, Klein C, et al. ABOincompatible organ transplantation. Int J Immunogenet 2012;39:282–90. Segev DL, Muzaale AD, Caffo BS, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA 2010;303:959–66. Greco F, Hoda MR, Alcaraz A, Bachmann A, Hakenberg OW, Fornara P. Laparoscopic living-donor nephrectomy: analysis of the existing literature. Eur Urol 2010;58:498–509. Ibrahim HN, Foley R, Tan L, et al. Long-term consequences of kidney donation. N Engl J Med 2009;360:459–69. Blanche C, Kamlot A, Blanche DA, et al. Combined heartkidney transplantation with single-donor allografts. J Thorac Cardiovasc Surg 2001;122:495–500. Pinderski LJ, Kirklin JK, McGiffin D, et al. Multi-organ transplantation: is there a protective effect against acute and chronic rejection? J Heart Lung Transplant 2005;24: 1828–33. Rana A, Robles S, Russo MJ, et al. The combined organ effect: protection against rejection? Ann Surg 2008;248:871–9. Sarris GE, Smith JA, Shumway NE, et al. Long-term results of combined heart-lung transplantation: the Stanford experience. J Heart Lung Transplant 1994;13:940–9. Vricella LA, Karamichalis JM, Ahmad S, Robbins RC, Whyte RI, Reitz BA. Lung and heart-lung transplantation in patients with end-stage cystic fibrosis: the Stanford experience. Ann Thorac Surg 2002;74:13–7; discussion 17–8. Bush A, Gabriel R. Pulmonary function in chronic renal failure: effects of dialysis and transplantation. Thorax 1991;46:424–8. Chan CH, Lai CK, Li PK, Leung CB, Ho AS, Lai KN. Effect of renal transplantation on pulmonary function in patients with end-stage renal failure. Am J Nephrol 1996;16:144–8. Ewert R, Opitz C, Wensel R, Dandel M, Mutze S, Reinke P. Abnormalities of pulmonary diffusion capacity in long-term survivors after kidney transplantation. Chest 2002;122: 639–44. Guleria S, Agarwal RK, Guleria R, Bhowmik D, Agarwal SK, Tiwari SC. The effect of renal transplantation on pulmonary function and respiratory muscle strength in patients with end-stage renal disease. Transplant Proc 2005;37:664–5. Karacan O, Tutal E, Colak T, Sezer S, Eyuboglu FO, Haberal M. Pulmonary function in renal transplant recipients and end-stage renal disease patients undergoing maintenance dialysis. Transplant Proc 2006;38: 396–400.
INVITED COMMENTARY Traditionally, renal failure in the setting of lung transplantation has been an ominous condition associated with poor survival. This is due to the exquisite sensitivity of the transplanted lung to shifts in volume status. Fluid retention associated with renal impairment is poorly tolerated in the lung allograft due to inability of the denervated graft to autoregulate blood flow and the lack of a functional lymphatic system within the transplanted lung to
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
remove excess alveolar fluid. These factors, combined with further postoperative immunosuppressive drug toxicity to the kidney days to months after lung transplantation, may necessitate some patients to undergo dialysis. Both peritoneal and hemodialysis have been shown to be poorly tolerated in lung transplant recipients [1]. For these reasons, most experienced transplant surgeons avoid performing lung transplants in patients who
0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2015.01.002
Ann Thorac Surg 2015;99:1032–9
OTANI ET AL KIDNEY TRANSPLANTATION AFTER LUNG/HEART-LUNG TRANSPLANTATION
This is one of the first papers to encourage centers to accept select patients for lung transplantation who have significant renal impairment and to provide hope to those individuals who develop end-stage renal failure after lung transplant. The frontiers of our specialty are being redefined and will continue to be refined as other centers report their experiences with similar groups of patients. Patricia A. Thistlethwaite, MD, PhD Division of Cardiothoracic Surgery University of California, San Diego 9300 Campus Point Dr La Jolla, CA 92037-7892 e-mail: [email protected]
References 1. Hennessy SA, Gillen JR, Hranjec T, et al. Influence of hemodialysis on clinical outcomes after lung transplantation. J Surg Res 2013;183:916–21. 2. Osho AA, Castleberry AW, Snyder LD, et al. Assessment of different threshold preoperative glomerular filtration rates as markers of outcomes in lung transplantation. Ann Thorac Surg 2014;98:283–9. 3. Otani S, Levvey BJ, Westall GP, et al. Long-term successful outcomes from kidney transplantation after lung and heartlung transplantation. Ann Thorac Surg 2015;99:1032–9. 4. OPTN/SRTR 2012 Annual Data Report: Kidney. Available at srtr. transplant.hrsa.gov/annual_reports/2012/pdf/01_kidney_13.pdf. Accessed February 2, 2015.
GENERAL THORACIC
have no expectation of renal recovery after lung transplant and whose glomerular filtration rate is less than 50 mL/minute per 1.73 m2 [2]. Clearly, a better approach is needed for this difficult group of patients. The paper by Otani and colleagues [3] takes a retrospective look at a single institution’s experience with combined lung–kidney transplantation as well as kidney transplantation months after lung transplantation. It is one of few papers to describe simultaneous lung–kidney transplantation in the medical literature. Although the numbers are small, they debunk the myths that, (1) simultaneous lung–kidney transplant should be avoided due to worse outcomes compared with lung transplant patients alone, and (2) kidney transplant for chronic renal failure after lung transplantation is associated with unacceptable long-term survival. The “take home” message of this paper is that patients with renal failure months after lung transplant are best managed by avoiding dialysis with preemptive kidney transplant or by minimizing dialysis time prior to kidney transplant. Because the average wait time for a kidney from a deceased donor in the United States is approximately 5 years [4], sequential lung–kidney transplant utilizing a cadaveric kidney after a long dialysis time is not an attractive option. Rather, identification and use of a living-related kidney donor appears crucial for limiting morbidity and mortality in the lung transplant patient who develops end-stage renal failure after transplant.
1039
