Pulmonary evaluation in potential kidney transplant candidates

<bold>Background:</bold> Relevant functional impairing conditions causing pulmonary hypertension, severe obstructive/restrictive lung disease or need for home oxygen therapy preclude kidney transplant (KT), hence why prior pulmonary evaluation is mandatory in patients (pts) with suspected respiratory disease/tobacco load >30 pack-years. Our study aims to report functional abnormalities and respiratory disease in KT candidates. <bold>Methods:</bold> Retrospective analysis of KT candidates priorly evaluated by Pulmonology, between 2021 and 2023. <bold>Results:</bold> Fifty pts; median age of 55 years (42–73); 70% male; 48% former-smokers, 36% smokers; 88% on hemodialysis, 8% on peritoneal dialysis; 4% without renal replacement therapy. Most with no known respiratory disease; 2 pts with bronchiectasis; 1 with emphysema; 3 with COPD; 4 with OSAS. The majority (48) underwent pulmonary function testing (PFT). According to the ERS/ATS 2005 criteria, 27 pts had no ventilatory disorder; 17 obstruction (1 severe, 6 moderate, 10 mild); 3 restriction (2 mild, 1 moderate); 1 lung hyperinflation. 19 had no changes in DLCO, 16 a mild reduction and 11 a moderate one. Pulmonology assessment allowed for establishing the following: emphysema (8), COPD (7), OSAS (4), pre-COPD (2), asthma (2), bronchiectasis (2), asthma/COPD overlap (1), post-COVID-19 interstitial abnormalities (1), pulmonary restriction due to obesity (1), RB-ILD (1). <bold>Conclusion:</bold> We report several functional abnormalities regarding pre-KT pts. Whether such abnormalities are bound to end-stage kidney disease or translate to undiagnosed lung disorders is unclear. Further data on respiratory assessment of selected KT candidates is warranted to better establish evaluation protocols, in which PFT play a major role.