lung assessment before kidney transplantation

1. LUNG EVALUATION in
kidney Transplantation
Gh. khanbabaee, MD
Pediatric Pulmonologist
MOFID Children`s Hospital
SBMU

2. • Patients with chronic renal failure are prone
to significant pulmonary comorbidities
• Patients who are selected for transplant
must have a thorough pre operative
pulmonary evaluation to assess pulmonary
status and to determine risk of
postoperative pulmonary complications
(POPCs)

3. • Pulmonary complications of
patients with chronic renal failure
• - pulmonary edema
• - pleural effusions
• - pulmonary hypertension
• - pulmonary fibrosis
• - pulmonary calcifications

4. Assessment of postoperative
pulmonary risk
• The Assess Respiratory Risk in
Surgical Patients in Catalonia
(ARISCAT) risk index was used to
predict the overall incidence of
POPCs (of any severity), by assigning
a weighted point score to 7
independent risk factors

5. Risk factors :
• Advanced age
• Low oxygen saturation
• Preoperative low hemoglobin level
• Type of incision
• Duration of surgery
• History of lower respiratory tract infection 1 month
before surgery
• Need for emergency surgery

6. Risk Factor Risk score
• Age (y)≤ 50 0
51-80 3
> 80 16
• Preoperative oxygen saturation
≥ 96% 0
91-95% 8
≤ 90% 24
• Respiratory infection in the last month 17

7. • Preoperative anemia (hemoglobin ≤ 10 g/dL) 11
• Surgical incision
Upper abdominal 15
Intrathoracic 24
• Duration of surgery
• < 2 hours 0
• 2-3 hours 16
• > 3 hours 23
• Emergency surgery 8
• Risk class Number of points in risk score
(pulmonary complication rate)
• Low < 26 points
• Intermediate 26-44 points
• High ≥ 45 points

9. Pulmonary complications of
renal disease
Pulmonary presentation
Pulmonary Edema
Pulmonary hypertension
Pleural effusion
Metastatic pulmonary calcification
Obstructive sleep apnea
Infections
Lymphoma/Lung cancer
Hypoxemia

10. Pre-Operative Pulmonary Evaluation
• General health
Overall general health has become a
good indicator of possible post-surgical
complications
Poor exercise tolerance is an indicator
of postoperative pulmonary risk

11. • Smoking
smoking is a modifiable risk factor for
patients undergoing elective surgery
• incidence of postoperative pulmonary
complications following upper
abdominal and thoracic surgery
fourfold increase in postoperative
atelectasis

12. • Obesity
BMI greater than or equal to 30 kg/m2
Morbid obesity causes a restrictive
ventilatory pattern and decreases
thoracic compliance and may lead to
alveolar hypoventilation

13. • Obstructive Sleep Apnea (OSA)
• Obstructive sleep apnea is defined as
the occurrence of at least five apneas
/hypopneas (temporary cessation of
breathing) in one hour
• All patients with OSA should undergo
a continuous positive airway pressure
(CPAP) titration

14. • Pulmonary function test
Pulmonary function testing is conducted
on all patients who are to undergo a
major surgical procedure
• Pulmonary function may be abnormal
in CRF patients due to various
mechanisms such as fluid overload,
infections, pleural effusions
pulmonary hypertension to improve
after renal transplantation

15. • Up to 88% of CRF patients showed
pulmonary function abnormalities which
improved significantly after transplantation
• Improvement was seen in mean vital
capacity and small airways small airways,
as shown by low maximal mid-expiratory
flow rates, which tended to improve after
renal transplantation

16. Pulmonary Complications of Chronic
Renal Disease
• Hypoxemia
• Pulmonary edema
• Pleural effusions
• Pulmonary Hypertension (PHTN)
• Metastatic pulmonary calcifications
• Lymphoma/Lung cancer

17. Definitions of postoperative pulmonary
complications
• Types of pulmonary complications within 1
month after transplant :
• Lower respiratory tract infection
• cough
• sputum production,
• T> 39°C
• Leukocytosis
• New lung infiltrates at radiography
• Pulmonary embolism
• Deep venous thrombosis

18. Pulmonary Complications Within
the First Month After Transplant
• Pleural effusion
• Pneumonia
• Respiratory failure
• Pulmonary embolism