Acute Kidney Disease After Liver and Heart Transplantation

Abstract

After transplantation of nonrenal solid organs, an acute decline in kidney function develops in the majority of patients. In addition, a significant number of nonrenal solid organ transplant recipients develop chronic kidney disease, and some develop end-stage renal disease, requiring renal replacement therapy. The incidence varies depending on the transplanted organ. Acute kidney injury after nonrenal solid organ transplantation is associated with prolonged length of stay, cost, increased risk of death, de novo chronic kidney disease, and end-stage renal disease. This overview focuses on the risk factors for posttransplant acute kidney injury after liver and heart transplantation, integrating discussion of proteinuria and chronic kidney disease with emphasis on pathogenesis, histopathology, and management including the use of mechanistic target of rapamycin inhibition and costimulatory blockade.

Renal protection strategies after heart transplantation

“…Proteinuria is another marker of kidney injury and indicates kidney parenchymal injury. Furthermore, proteinuria is a risk factor for AKI and increases the cardiovascular risk . Whenever possible, nephrotoxic agents should be omitted in all pre‐HTx patients.…”

“…When hospitalized, these patients are candidates for intravenous inotropic support to increase cardiac output and organ perfusion . The main principles of managing renal failure (either AKI or CKD) have been described before . The key challenge of transplant physicians is addressing the constantly changing choices and combinations of immunosuppressive therapy.…”

“…A rare cause of renal failure post‐ HT x is BK virus ( BKV ). Advanced age, female sex, hypertension, diabetes mellitus, and drugs are significantly associated with CKD post‐ HT x…”

“…Furthermore, proteinuria is a risk factor for AKI and increases the cardiovascular risk. 13 Whenever possible, nephrotoxic agents should be omitted in all pre-HTx patients. When hospitalized, these patients are candidates for intravenous inotropic support to increase cardiac output and organ perfusion.…”

“…14 The main principles of managing renal failure (either AKI or CKD) have been described before. 13,15 The key challenge of transplant physicians is addressing the constantly changing choices and combinations of immunosuppressive therapy. Such decisions involve considering the mitigation of the risks associated with AKI and CKD and the prevention of allograft rejection and death.…”