C47-24 Kidney Transplant Improves Survival in Lung Transplant Recipients With Subsequent Chronic Kidney Disease: A Single Center Study

Abstract Rationale Chronic renal dysfunction that requires renal replacement therapy (cRRT) occurs in ∼15% of lung transplant (LTx) recipients. Many of these patients will undergo chronic dialysis (cD), which places a significant burden on the patient and decreases their quality of life. The effect of subsequent kidney transplantation (KTx) relative to cD on long-term survival has not been well-documented. This study compares survival among lung transplant recipients with chronic kidney failure managed with cD versus those who undergo KTx. Methods Data from all LTx recipients from 1988 - 2024 at a high-volume center were retrospectively reviewed for incidence of cRRT, either cD or KTx, after LTx,. Transplant information, demographics, cRRT information, and post-transplant survival were extracted from the electronic health record via our institutional research data repository. Patients were excluded from the study if KTx occurred at the same time as LTx. Individuals in the cD group were matched to those in the KTx group based on years from LTx to cRRT initiation, using up to four matches per case. Survival time between groups were compared using stratified Cox proportional hazards models. Results During the study period 2611 LTx were performed, of which 470 developed chronic renal failure (n = 376 cD, n = 94 KTx). The 94 KTx recipients were matched to 253 LTx recipients on cD. The median (IQR) number of days to initiation of cRRT for all individuals was 1251 days (292.25, 2727.75). The Cox proportional hazard model indicated a 93% reduction in mortality risk associated with KTx compared with continued cRRT at 5 years from LTx (HR = 0.07; 95% CI 0.02 - 0.19; Figure 1). Additionally, Cox proportional hazard model showed 90.3% reduction in mortality risk associated with KTx at any given point within the follow up period (through June of 2025). In follow-up analyses, adjusting for patients’ demographic characteristics such as age and gender and subgroup analyses of short and long duration between LTx and cRRT did not change this finding. Conclusions These results suggest that KTx confers a survival benefit over cD as cRRT after LTx. Though selection bias associated with suitable KTx candidacy may be present, the substantial long-term survival of those receiving KTx after LTx demonstrates clear benefit to this approach. These findings can inform decision-making at the time of renal failure by viewing KTx as a viable option for cRRT. This abstract is funded by: None