Chronic Renal Failure after Transplantation of a Nonrenal Organ

Ojo, Akinlolu; Held, Philip J.; Port, Friedrich K.; Wolfe, Robert A.; Leichtman, Alan B.; Young, Eric W.; Arndorfer, Julie; Christensen, Laura; Merion, Robert M.

doi:10.1056/nejmoa021744

Cited by 1,967 publications

(1,831 citation statements)

References 42 publications

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“…1,2 This has coincided with a rise in combined liver-kidney transplantation (CLKT) in the past 7 years. Impaired renal function at the time of transplantation has been shown to have a detrimental impact on morbidity and mortality after liver transplantation.…”

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confidence: 99%

Pretransplant predictors of recovery of renal function after liver transplantation

et al. 2010

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The Model for End-Stage Liver Disease system has given priority on the liver transplant waiting list to candidates with renal failure. This study determined the predictors of spontaneous recovery of renal function after transplantation in 1041 liver transplant recipients on renal replacement therapy (RRT) at the time of transplant (from February 2002 to January 2007). Data from these patients were obtained from the US Organ Procurement and Transplantation Network and US Renal Data System databases. Univariate and multivariate survival models were constructed along with multivariate logistic regression models to find independent predictors of spontaneous renal recovery. Seven hundred seven recipients (67.9%) had spontaneous recovery of renal function after liver transplantation. Those recovering spontaneously had a significantly shorter course of RRT in the pretransplant time period (15.6 versus 36.6 days, P < 0.001). Recovery of renal function was observed in 70.8% and 11.5% of recipients on RRT for less than 30 days and more than 90 days, respectively. Other statistically significant pretransplant variables independently associated with recovery of renal function included recipient age, recipient pretransplant diabetes, and donor age. In conclusion, the duration of pretransplant RRT is highly predictive of spontaneous renal recovery post-transplant. Liver transplant candidates requiring less than 30 days of pretransplant RRT are likely to spontaneously recover renal function after liver transplantation, whereas those on RRT for more than 90 days are not. In the era of Model for End-Stage Liver Disease (MELD)-based liver allocation, there has been a preference for organ allocation to those patients with renal dysfunction, with the result that more than 30% of patients awaiting liver transplantation have decreased renal function, including a substantial number that require renal replacement therapy (RRT). 1,2 This has coincided with a rise in combined liver-kidney transplantation (CLKT) in the past 7 years. Impaired renal function at the time of transplantation has been shown to have a detrimental impact on morbidity and mortality after liver transplantation. 2,3 Despite imprecise methods for measuring renal dysfunction, 4 it is clear that the pretransplant degree of renal insufficiency has a major impact on post-transplant survival. 5 Specifically, the length of pretransplant renal dysfunction predicts post-transplant renal insufficiency. Campbell et al. 6 demonstrated that the duration of pretransplant Abbreviations: CI, confidence interval; CLKT, combined liver-kidney transplantation; INR, international normalized ratio; MELD, Model for End-Stage Liver Disease; N/A, not available; OR, odds ratio; RRT, renal replacement therapy; UNOS,

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confidence: 99%

Pretransplant predictors of recovery of renal function after liver transplantation

et al. 2010

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“…It has been reported that approximately 20% of liver transplant recipients have end-stage renal disease 10 years after transplantation. 8 Unexpectedly, the incidence of endstage renal disease is higher in liver transplant recipients versus heart or lung transplant recipients. There is a rapid increase in the incidence of chronic renal failure within the first year after transplantation, and this is followed by slower (though relentless) increases after the first year.…”

Section: Continuing Burden Of Impaired Renal Function After Liver Tramentioning

confidence: 99%

“…Female sex, hepatitis C virus infections, diabetes mellitus, hypertension, and postoperative acute renal failure are independent predictive factors of chronic renal failure in the long term. 8 Importantly, several series have shown that liver transplant recipients who develop chronic renal failure have worse outcomes than those who do not. [8][9][10] Kidney biopsy samples from liver transplant recipients with impaired renal function in the long term have shown that interstitial fibrosis and glomerular sclerosis may each be present in 45%.…”

Section: Continuing Burden Of Impaired Renal Function After Liver Tramentioning

confidence: 99%

“…8 Importantly, several series have shown that liver transplant recipients who develop chronic renal failure have worse outcomes than those who do not. [8][9][10] Kidney biopsy samples from liver transplant recipients with impaired renal function in the long term have shown that interstitial fibrosis and glomerular sclerosis may each be present in 45%. 11 Calcineurin inhibitor (CNI)-induced arteriolopathy may also be present in approximately 45% of these patients 5 years after transplantation.…”

Section: Continuing Burden Of Impaired Renal Function After Liver Tramentioning

confidence: 99%

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Hot-topic debate on kidney function: Renal-sparing approaches are beneficial

Durand

2011

Liver Transpl

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“…There are multiple causes for the lack of progress in long‐term outcomes, including the adverse effects of calcineurin inhibitors on cardiovascular risk factors, which can lead to premature death with a functioning graft;2, 3 calcineurin inhibitor–associated nephrotoxicity;4, 5, 6 and chronic antibody‐mediated rejection. A calcineurin inhibitor–free immunosuppressive regimen could potentially provide improved efficacy, safety, and preservation of renal function.…”

Section: Introductionmentioning

confidence: 99%

Ten-year outcomes in a randomized phase II study of kidney transplant recipients administered belatacept 4-weekly or 8-weekly

Vincenti

Blancho

Dürrbach

et al. 2017

American Journal of Transplantation

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In the phase II IM103‐100 study, kidney transplant recipients were first randomized to belatacept more‐intensive‐based (n = 74), belatacept less‐intensive‐based (n = 71), or cyclosporine‐based (n = 73) immunosuppression. At 3‐6 months posttransplant, belatacept‐treated patients were re‐randomized to receive belatacept every 4 weeks (4‐weekly, n = 62) or every 8 weeks (8‐weekly, n = 60). Patients initially randomized to cyclosporine continued to receive cyclosporine‐based immunosuppression. Cumulative rates of biopsy‐proven acute rejection (BPAR) from first randomization to year 10 were 22.8%, 37.0%, and 25.8% for belatacept more‐intensive, belatacept less‐intensive, and cyclosporine, respectively (belatacept more‐intensive vs cyclosporine: hazard ratio [HR] = 0.95; 95% confidence interval [CI] 0.47‐1.92; P = .89; belatacept less‐intensive vs cyclosporine: HR = 1.61; 95% CI 0.85‐3.05; P = .15). Cumulative BPAR rates from second randomization to year 10 for belatacept 4‐weekly, belatacept 8‐weekly, and cyclosporine were 11.1%, 21.9%, and 13.9%, respectively (belatacept 4‐weekly vs cyclosporine: HR = 1.06, 95% CI 0.35‐3.17, P = .92; belatacept 8‐weekly vs cyclosporine: HR = 2.00, 95% CI 0.75‐5.35, P = .17). Renal function trends were estimated using a repeated‐measures model. Estimated mean GFR values at year 10 for belatacept 4‐weekly, belatacept 8‐weekly, and cyclosporine were 67.0, 68.7, and 42.7 mL/min per 1.73 m2, respectively (P<.001 for overall treatment effect). Although not statistically significant, rates of BPAR were 2‐fold higher in patients administered belatacept every 8 weeks vs every 4 weeks.

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Chronic Renal Failure after Transplantation of a Nonrenal Organ

Cited by 1,967 publications

References 42 publications

Pretransplant predictors of recovery of renal function after liver transplantation

Pretransplant predictors of recovery of renal function after liver transplantation

Hot-topic debate on kidney function: Renal-sparing approaches are beneficial

Ten-year outcomes in a randomized phase II study of kidney transplant recipients administered belatacept 4-weekly or 8-weekly

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