CKD in Recipients of Nonkidney Solid Organ Transplants: A Review

Wiseman, Alexander C.

doi:10.1053/j.ajkd.2021.10.014

Cited by 8 publications

(9 citation statements)

References 79 publications

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“…Moreover, the relative lower target levels currently applied in liver transplantation in comparison to other types of solid organ transplantation could be an important additional factor for limiting its negative impact on renal function. This also means that our findings are perhaps less relevant for other types of transplantation with higher CNI exposure, where progressive renal failure is more prominent over time 31 …”

Section: Discussionmentioning

confidence: 86%

A longitudinal study of long‐term renal outcome after pediatric liver transplantation in relation to CNI exposure

Vandewiele,

Herman,

van den Heuvel

et al. 2023

Pediatric Transplantation

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BackgroundChronic kidney disease (CKD) is reported in 20%–30% of children after liver transplantation (LT). One of the proposed underlying causes is the long‐term exposure to tacrolimus, a calcineurin inhibitor (CNI), which is the main immunosuppressive drug used after LT. Variation in tacrolimus absolute exposure and relative dose requirements are believed to be important risk factors for developing CNI‐associated nephrotoxicity.AimTo describe the long‐term renal outcome of pediatric LT recipients and determine the effects of tacrolimus exposure on renal outcome parameters.MethodsRetrospective single center study of renal function (GFR, proteinuria) and pharmacokinetic parameters (C0, AUC0–12h) obtained during annual follow‐up in children after liver transplantation, between 1998 and 2019. Relevant pharmacogenetic variants for tacrolimus disposition (CYP3A5 and ABCB1) were determined in recipients and donors. The evolution of individual renal function and tacrolimus exposure was evaluated using linear mixed models for repeated measurements.ResultsTwenty‐six children were included (mean follow‐up: 10.4 years (range 2–18.9)). Mean estimated GFR was 109.3 (SE: 7.4), vs. measured: 91.3 mL/min/1.73 m2 (SE: 6.3), which remained stable during follow‐up. CKD stage ≥2 was observed in 32.8% of the visits based on eGFR versus 50.0% on mGFR. CKD stage ≥3 was uncommon (4.1% and 6.2% resp.). Mean tacrolimus C0 was 5.3 ng/mL (SE: 2.5) with a AUC0–12h of 72.7 ng*h/mL (SE: 30.3), which demonstrated a small decrease during follow‐up. There was a negative correlation between C0 and mGFR (rS = −0.3; p < .001). We found no correlation between GFR and tacrolimus dose requirements ((ng/mL)/(mg/kg)) or pharmacogenetic background.ConclusionRenal function during long‐term follow‐up after pediatric LT remained stable for the majority of our cohort. However, mild CKD was relatively common, warranting follow‐up into adulthood. Although absolute tacrolimus exposure has a small depressing effect on concurrent GFR, there is no progressive deterioration of GFR due to long‐term exposure, dose requirements or genetic background under the current target levels. These findings should be confirmed in a larger sample set, ideally including data from multiple centers.

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Section: Discussionmentioning

confidence: 86%

A longitudinal study of long‐term renal outcome after pediatric liver transplantation in relation to CNI exposure

Vandewiele,

Herman,

van den Heuvel

et al. 2023

Pediatric Transplantation

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“…One of the remarkable findings in our study was the low rate of follow-up by the nephrology department despite CKD. In the literature, joint follow-up with nephrology has been associated with fewer cardiovascular events in liver transplant patients [12] and better management both before and after liver [13], heart, and lung [14] transplantation.…”

Section: Discussionmentioning

confidence: 99%

Role of the Nephrologist in Non-Kidney Solid Organ Transplant (NKSOT)

Viejo-Boyano¹,

López-Romero²,

D’Marco³

et al. 2023

Preprint

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Background: Chronic kidney disease (CKD) is a common complication of non-kidney solid organ transplant (NKSOT). Identifying predisposing factors is crucial for an early approach and correct referral to nephrology. Methods: This is a single-center retrospective observational study of a cohort of CKD patients under follow-up in Nephrology Department between 2010 to 2020. Statistical analysis was performed between all the risk factors and four dependent variables: end-stage renal disease (ESKD), increased serum creatinine ≥50%, renal replacement therapy (RRT), and death in pre-transplant, peri-transplant and post-transplant period. Results: 74 patients were studied (7 heart transplant, 34 liver transplants, and 33 lung transplant). Patients who were not followed-up by nephrology in the pre-transplant (p&lt;0.027), peri-transplant (p&lt;0.046), and the longest time until outpatient clinic follow-up (HR 1,032) were associated with a higher risk of creatinine increase ≥50%. Receiving a lung transplant conferred higher risk than liver or hear transplant for developing a creatinine increase ≥50% and ESKD. Peri-transplant mechanical ventilation, peri-transplant and post-transplant anticalcineurin overdose, nephrotoxic and the number of hospital admissions were significantly associated to present a creatinine increase ≥50% and develop ESKD. Conclusion: An early follow-up by the nephrology department was associated with a decrease in the worsening of renal function.

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“…In a recent review, Wiseman[ 12 ], as adapted from Schwarz et al [ 13 ], describes the clinical characteristics and histology of biopsy proven kidney disease after liver, lung and heart transplantation. Of note, primary glomerulonephritis was 26% in liver transplant recipients and acute tubular injury were the most commonly observed histologic patterns in lung and heart recipients.…”

Section: Mechanisms Leading To Ckd In Non-kidney Sotmentioning

confidence: 99%

“…In other words, the same diseases processes that effect native kidney function remain relevant after SOT. The literature/guidelines describing CKD management are well described and summarizing them is beyond the scope of this review[ 1 , 12 , 50 ]. The impact of therapies and management strategies for risk factors leading to CKD in NKSOT is understudied.…”

Section: Diagnosis and Management Of Ckd Post Non-kidney Sotmentioning

confidence: 99%

“…The integration of nephrology care into dedicated NKSOT care throughout various stages of pre-, peri-, and post-transplantation is critical for diagnosis and management of kidney disease. Wiseman[ 12 ], in his recent review, provides substantive recommendations on timing/appropriateness of nephrology referral, based on KDIGO guidelines, and management considerations across transplant timepoints in tabular form. As has been described throughout this study, SOT recipients are a unique subset of patients with CKD that often progresses to ESKD necessitating RRT.…”

Section: Diagnosis and Management Of Ckd Post Non-kidney Sotmentioning

confidence: 99%

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Kidney disease in non-kidney solid organ transplantation

Swanson¹

2022

WJT

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Kidney disease after non-kidney solid organ transplantation (NKSOT) is a common post-transplant complication associated with deleterious outcomes. Kidney disease, both acute kidney injury and chronic kidney disease (CKD) alike, emanates from multifactorial, summative pre-, peri- and post-transplant events. Several factors leading to kidney disease are shared amongst solid organ transplantation in addition to distinct mechanisms unique to individual transplant types. The aim of this review is to summarize the current literature describing kidney disease in NKSOT. We conducted a narrative review of pertinent studies on the subject, limiting our search to full text studies in the English language. Kidney disease after NKSOT is prevalent, particularly in intestinal and lung transplantation. Management strategies in the peri-operative and post-transplant periods including proteinuria management, calcineurin-inhibitor minimization/ sparing approaches, and nephrology referral can counteract CKD progression and/or aid in subsequent kidney after solid organ transplantation. Kidney disease after NKSOT is an important consideration in organ allocation practices, ethics of transplantation. Kidney disease after SOT is an incipient condition demanding further inquiry. While some truths have been revealed about this chronic disease, as we have aimed to describe in this review, continued multidisciplinary efforts are needed more than ever to combat this threat to patient and allograft survival.

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CKD in Recipients of Nonkidney Solid Organ Transplants: A Review

Cited by 8 publications

References 79 publications

A longitudinal study of long‐term renal outcome after pediatric liver transplantation in relation to CNI exposure

A longitudinal study of long‐term renal outcome after pediatric liver transplantation in relation to CNI exposure

Role of the Nephrologist in Non-Kidney Solid Organ Transplant (NKSOT)

Kidney disease in non-kidney solid organ transplantation

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