Assessment of respiratory function in children after kidney transplantation

Abstract

Background: Severe respiratory complications following kidney transplantation have been reported, yet remain poorly understood in the pediatric population. This study aimed to document respiratory disease in this population.

Methods: At annual follow-ups, patients completed a respiratory symptoms questionnaire and underwent pulmonary function tests (PFTs). We defined respiratory disease in children when they had clinical disorders and/or PFT abnormalities.

Results: Among 236 children included, 110 (41%) exhibited respiratory involvement: 59 (53%) had only clinical disorders, 38 (35%) had only PFT abnormalities, and 13 (12%) had both. Of those with PFT abnormalities, 15 (7%) had obstructive impairment, 12 (6%) had restrictive impairment, and 30 (24%) showed decreased lung diffusion capacity for carbon monoxide (DLCO)/transfer coefficient for carbon monoxide (KCO). In the multivariate analysis, being over 3.5 years of age at the time of transplantation was associated with a reduced risk of respiratory involvement (OR 0.30, CI [0.14; 0.63], p = 0.002), such as induction with basiliximab (OR 0.39, CI [0.17; 0.90], p = 0.03). Conversely, history of immune deficiency, male gender, positive PCR for BK virus and diastolic hypertension were associated with an increased risk (OR 5.96, CI [2.15; 16.51], p = 0.0006, OR 1.97, CI [1.03; 3.77], p = 0.04, OR 3.77, CI [1.14; 12.52], p = 0.03 and OR 2.21, CI [1.13; 4.32], p = 0.02, respectively). Bronchial lesions, such as bronchiectasis, were predominantly observed on tomography.

Conclusions: Given the risk of irreversible lung damage, we recommend systematic clinical and functional respiratory monitoring in case of respiratory symptoms, recurrent lower respiratory tract infections, and risk factors in their follow-up.

Keywords: Children; Kidney transplantation; Pulmonary function; Respiratory disease.