An Emerging Population

Srinivas, Titte R.; Stephany, Brian; Budev, Marie; Mason, David P.; Starling, Randall C.; Miller, Charles M.; Goldfarb, David A.; Flechner, Stuart M.; Poggio, Emilio D.; Schold, Jesse D.

doi:10.2215/cjn.02950410

Cited by 60 publications

(35 citation statements)

References 18 publications

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“…Although the number of patients is small, non-renal transplant recipients represent a growing segment of the kidney transplant wait list. Evidence indicates that these patients receive a survival benefit from kidney transplantation compared with remaining on the kidney wait list (8)(9)(10)(11)(12). Taken together, these findings indicate that nonrenal transplant recipients with subsequent chronic renal disease are at increased risk of mortality and those who are candidates for kidney transplantation receive a substantial survival benefit.…”

Section: Introductionmentioning

confidence: 90%

The Influence of Induction Therapy for Kidney Transplantation after a Non-Renal Transplant

Cassuto¹,

Levine²,

Reese

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Non-renal transplant recipients who subsequently develop ESRD and undergo kidney transplantation are medically and immunologically complex due to comorbidities, high cumulative exposure to immunosuppressants, and sensitization to alloantigen from the prior transplant. Although prior non-renal transplant recipients are one of the fastest growing segments of the kidney wait list, minimal data exist to guide the use of antibody induction therapy (IT+) at the time of kidney after lung (KALu), heart (KAH), and liver (KALi) transplant.Design, setting, participants, & measurements This retrospective cohort study used national registry data to examine IT use and survival after kidney transplantation. Separate multivariate Cox regression models were constructed to assess patient survival for IT+ and IT2 KALu (n=232), KAH (n=588), and KALi (n=736) recipients.

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Section: Introductionmentioning

confidence: 90%

The Influence of Induction Therapy for Kidney Transplantation after a Non-Renal Transplant

Cassuto¹,

Levine²,

Reese

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…From 1995 to 2008, the number of patients placed on the kidney transplant waiting list for a sequential kidney following prior nonrenal solid‐organ transplantation increased dramatically (330% for previous liver, 307% for previous heart, and 635% for previous lung transplants). Over the same time period, there was only a 74% increase in wait‐listing in primary kidney transplant patients and 70% in repeat kidney patients …”

Section: Introductionmentioning

confidence: 99%

Outcome of kidney transplant in primary, repeat, and kidney‐after‐nonrenal solid‐organ transplantation: 15‐year analysis of recent UNOS database

El-Husseini

Aghil

Ramírez

et al. 2017

Clinical Transplantation

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The number of nonrenal solid-organ transplants increased substantially in the last few decades. Many of these patients develop renal failure and receive kidney transplantation. The aim of this study was to evaluate patient and kidney allograft survival in primary, repeat, and kidney-after-nonrenal organ transplantation using national data reported to United Network for Organ Sharing (UNOS) from January 2000 through December 2014. Survival time for each patient was stratified into the following: Group A (comparison group)-recipients of primary kidney transplant (178 947 patients), Group B-recipients of repeat kidney transplant (17 819 patients), and Group C-recipients of kidney transplant performed after either a liver, heart, or lung transplant (2365 patients). We compared survivals using log-rank test. Compared to primary or repeat kidney transplant, patient and renal allograft survival was significantly lower in those with previous nonrenal organ transplant. Renal allograft and patient survival after liver, heart, or lung transplants are comparable. Death was the main cause of graft loss in patients who had prior nonrenal organ transplant.

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“…Third, some studies report that SLK transplant recipients may have shorter kidney graft and patient survival rates compared to kidney‐alone recipients . And finally, the mortality for LT recipients waiting for a kidney transplant (KT) is substantially higher than KT‐alone recipients …”

Section: Introductionmentioning

confidence: 99%

The liver recipient with acute renal dysfunction: A single institution evaluation of the simultaneous liver‐kidney transplant candidate

Yadav

Serrano

Peterson

et al. 2017

Clinical Transplantation

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The Organ Procurement Transplant Network (OPTN) listing criteria for simultaneous liver-kidney transplant (SLK) are not well defined. Concerns remain about rising numbers of SLKs, which divert quality kidneys from candidates awaiting kidney transplants (KT). We performed a retrospective review of liver transplants (LTs) at our center from 2004 to 2014; 127 recipients (liver transplant alone; 102 LTA, 25 SLK) were identified with short-term preoperative kidney dysfunction (creatinine >4 mg/dL or preoperative hemodialysis [HD] for <6 weeks). Both cohorts had comparable baseline demographic characteristics with the exception of higher model for end-stage liver disease (MELD) score in the LTA group (41.4 vs 32.9, P < .0001) and higher incidence of pre-LT diabetes in the SLK cohort (52% vs 26.5%, P = .0176). Duration of pre-LT HD was higher in SLK recipients, but the difference was not statistically significant (P = .39).Renal nonrecovery (RNR) rate in LTA cohort was low (<5%). No significant difference was noted in 1-year mortality, liver graft rejection/failure, or length of stay (LOS) between the cohorts. Thus, it appears that liver recipients with short-term (<6 weeks) HD or AKI without HD have comparable outcomes between LTA and SLK. With provisions for a KT safety net, as proposed by OPTN, LTA may be the most adequate option for these patients.

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An Emerging Population

Abstract: Background and objectives: ESRD has an adverse impact on patients who have had previous nonrenal solid-organ transplants (NRTxs; liver, heart, lung) and may be referred for a kidney transplant (KTx).Design

Cited by 60 publications

References 18 publications

The Influence of Induction Therapy for Kidney Transplantation after a Non-Renal Transplant

The Influence of Induction Therapy for Kidney Transplantation after a Non-Renal Transplant

Outcome of kidney transplant in primary, repeat, and kidney‐after‐nonrenal solid‐organ transplantation: 15‐year analysis of recent UNOS database

The liver recipient with acute renal dysfunction: A single institution evaluation of the simultaneous liver‐kidney transplant candidate

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