Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation

Bloom, Roy D.; Reese, Peter P.

doi:10.1681/asn.2007040394

Cited by 161 publications

(141 citation statements)

References 105 publications

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“…This is a well-described clinical and histologic entity in solid organ transplantation (10)(11)(12)(13)(14) (42)(43)(44). Studies in cardiac transplantation are focusing on an approach using MMF with small doses of cyclosporine (45,46 …”

Section: Calcineurin-inhibitor Nephrotoxicitymentioning

confidence: 99%

Renal Histopathological Lesions After Lung Transplantation in Patients with Cystic Fibrosis

Lefaucheur

Nochy²,

Amrein³

et al. 2008

American Journal of Transplantation

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We have analyzed the evolution of renal status beyond the perioperative period in patients with cystic fibrosis (CF) undergoing lung transplantation and presented histological analysis of 15 patients biopsied for an episode of accelerated renal function loss (RFL). The identification of specific etiologies of progressive kidney disease in patients with CF after lung transplantation should permit more effective post-transplant care of these patients. Episodes of accelerated RFL

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Section: Calcineurin-inhibitor Nephrotoxicitymentioning

confidence: 99%

Renal Histopathological Lesions After Lung Transplantation in Patients with Cystic Fibrosis

Lefaucheur

Nochy²,

Amrein³

et al. 2008

American Journal of Transplantation

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“…2 Risk factors for development of CKD include pretransplant factors, including preexisting CKD, advanced age, diabetes, hypertension, hepatitis C, and posttransplant factors, including early acute kidney injury, diabetes, and CNI use. 2,42,43 Duration and etiology of pretransplant renal failure, in particular, are important predictors of posttransplant CKD. Patients with pretransplant hepatorenal syndrome are expected to recover renal function owing to an absence of parenchymal renal disease.…”

Section: Chronic Kidney Diseasementioning

confidence: 99%

“…44,45 Most other patients with stage 4 or 5 CKD who have end-stage liver disease often undergo combined liver-kidney transplant. 43,45 Prolonged ischemic or toxic insults, such as hemodynamic instability, severe sepsis, and nephrotoxic drugs including iodinated contrast exposure, increase risk of renal injury before and after transplant. Calcineurin inhibitors nephrotoxicity is extremely common in patients taking these medications.…”

Section: Chronic Kidney Diseasementioning

confidence: 99%

“…46 Chronic CNI nephropathy is usually asymptomatic, with a gradual decline in renal function that includes a bland urine sediment and mild proteinuria. 43 Steps to prevent the development and progression of renal failure include identifying patients with CKD at risk for posttransplant renal failure, avoiding renal hypoperfusion, maintaining optimal control of hypertension and diabetes and avoiding nephrotoxic medications, including nonsteroidal anti-inflammatory medications, and contrast exposure. 43 Calcium channel blockers and ACEi's or angiotensin receptor blockers may be nephroprotective against CNI-induced injury.…”

Section: Chronic Kidney Diseasementioning

confidence: 99%

“…43 Steps to prevent the development and progression of renal failure include identifying patients with CKD at risk for posttransplant renal failure, avoiding renal hypoperfusion, maintaining optimal control of hypertension and diabetes and avoiding nephrotoxic medications, including nonsteroidal anti-inflammatory medications, and contrast exposure. 43 Calcium channel blockers and ACEi's or angiotensin receptor blockers may be nephroprotective against CNI-induced injury. 13,47 Discussion with the transplant center for reduction in the dose of CNIs, combining low-dose CNIs with renal-sparing MMF with or without concomitant glucocorticoids, could be considered.…”

Section: Chronic Kidney Diseasementioning

confidence: 99%

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Long-term Medical Management of the Liver Transplant Recipient: What the Primary Care Physician Needs to Know

Singh

Watt

2012

Mayo Clinic Proceedings

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Recognition, management, and prevention of medical complications and comorbidities after liver transplant is the key to improved long-term outcomes. Beyond allograft-related complications, metabolic syndrome, cardiovascular disease, renal dysfunction, and malignancies are leading causes of morbidity and mortality in this patient population. Primary care physicians have an important role in improving outcomes of liver transplant recipients and are increasingly relied on for managing these complex patients. This review serves to assist the primary care physician in the long-term management issues of liver transplant recipients.

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Impact of tacrolimus versus cyclosporin A on renal function during the first year after heart transplant

et al. 2020

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Aims Nephrotoxicity of calcineurin inhibitors (CNIs) is associated with adverse events in patients undergoing heart transplant (HTx), although studies directly comparing tacrolimus (TAC) versus cyclosporin A (CsA), especially in combination with everolimus and low-dose CNIs approach, are limited. Thus, we sought to investigate the associations of TAC and CsA with clinical outcomes in HTx recipients, with specific focus on renal function. Methods and results From August 2007 to February 2017, 72 consecutive patients (39 treated with TAC vs. 33 with CsA) receiving de novo HTx in a single transplant centre were retrospectively evaluated. We used the instrumental variable method to account for unmeasured confounding. The study outcomes were percentage change in estimated glomerular filtration rates (eGFR) (safety endpoint) and biopsy-proven acute rejection (efficacy endpoint) within the first year after HTx. The enrolled patients (median age 40 years) were predominantly men (68%). There were no significant differences in baseline characteristics, including eGFR (64.8 [45.7-96.4] mL/min/1.73 m 2 in TAC vs. 65.6 [57.9-83.0] mL/min/1.73 m 2 for CsA; P = 0.48), other than sex (male, 49% for TAC vs. 91% for CsA; P < 0.001) between the two groups. Within the first year after HTx, 23 (59%) in the TAC group switched mycophenolate mofetil to everolimus, whereas 16 (48%) in the CsA group (P = 0.52). At 12 months, the rates of mortality and end-stage renal disease requiring renal replacement therapies were both 0%. In the instrumental variable analysis, no differences in renal function as well as graft rejection for 1 year after HTx existed between the TAC and CsA groups. These results were similar when taking into account of everolimus use. Conclusions Irrespective of everolimus use with low-dose CNIs, our analysis using the instrumental variable method showed no differences in renal function as well as graft rejection during the first year after HTx between HTx recipients who received TAC or CsA.

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Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation

Cited by 161 publications

References 105 publications

Renal Histopathological Lesions After Lung Transplantation in Patients with Cystic Fibrosis

Renal Histopathological Lesions After Lung Transplantation in Patients with Cystic Fibrosis

Long-term Medical Management of the Liver Transplant Recipient: What the Primary Care Physician Needs to Know

Impact of tacrolimus versus cyclosporin A on renal function during the first year after heart transplant

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