Department of Urology, Foch Hospital, Suresnes, France.
Department of Thoracic Surgery and Lung Transplantation, Foch Hospital, Suresnes, France.
Ann Transplant. 2024 Aug 13;29:e944049. doi: 10.12659/AOT.944049.
BACKGROUND End-stage renal disease is a major issue in the management of patients undergoing lung transplantation. Combined kidney-lung transplantation (CKLT) and kidney after lung transplantation (KALT) are the 2 preferred solutions to manage this situation. To evaluate these strategies, we describe kidney and lung graft outcomes and patient survival in patients managed with CKLT and KALT. MATERIAL AND METHODS We conducted a retrospective single-center cohort study. Patients who underwent a CKLT or a KALT were included in this study. Retrospective extraction of data from medical records was performed. RESULTS Seventeen patients underwent CKLT and 9 underwent KALT. Most of the patients had cystic fibrosis and presented renal failure related to anti-calcineurin toxicity. The 30-day and 1-year survival of CKLT recipients were both 75.6%. No patients with KALT died during the follow-up. Kidney graft prognosis was almost exclusively influenced by patient survival in relation to postoperative lung transplant complications. The rate of severe surgical complications was close to 60% for CKLT compared with 30% for KALT. The kidney graft function (estimated kidney graft function) did not differ according to the transplantation strategy. CONCLUSIONS KALT is a safe option, with postoperative morbidity and renal graft function identical to those of kidney transplantation in non-lung-transplanted patients. The results of CKLT depend mainly on the morbidity associated with lung transplantation but remain an attractive option for patients with respiratory failure associated with end-stage renal disease. The choice of transplant strategy must also take into account the most ethical and efficient allocation of kidney grafts.
终末期肾病是肺移植患者管理中的一个主要问题。联合肾肺移植（CKLT）和肺移植后肾移植（KALT）是解决这一问题的两种首选方案。为了评估这些策略，我们描述了接受 CKLT 和 KALT 治疗的患者的肾脏和肺移植物的结局和患者的存活率。
我们进行了一项回顾性单中心队列研究。将接受 CKLT 或 KALT 的患者纳入本研究。从病历中回顾性提取数据。
17 名患者接受了 CKLT，9 名患者接受了 KALT。大多数患者患有囊性纤维化，并因钙调磷酸酶抑制剂毒性而出现肾衰竭。CKLT 受者的 30 天和 1 年存活率均为 75.6%。随访期间，无 KALT 患者死亡。肾脏移植物的预后几乎完全受与术后肺移植并发症相关的患者存活率的影响。CKLT 的严重手术并发症发生率接近 60%，而 KALT 为 30%。根据移植策略，肾脏移植物的功能（估计的肾脏移植物功能）没有差异。
KALT 是一种安全的选择，术后发病率和肾脏移植物功能与非肺移植患者的肾脏移植相同。CKLT 的结果主要取决于与肺移植相关的发病率，但对于因终末期肾病而导致呼吸衰竭的患者仍然是一个有吸引力的选择。移植策略的选择还必须考虑到最符合伦理道德和最有效的肾脏移植物分配。
