Donor Phosphorus Levels and Recipient Outcomes in Living-Donor Kidney Transplantation

Chang, P. C.; Saha, Sharmeela; Gomes, Amanda Medeiros; Padiyar, Aparna; Bodziak, Kenneth A.; Poggio, Emilio D.; Hricik, Donald E.; Augustine, Joshua J.

doi:10.2215/cjn.03220410

Cited by 4 publications

(4 citation statements)

References 29 publications

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“…Several studies have shown associations between serum phosphorus levels and decline in renal function in pediatric and adult patients with CKD (8-10), and graft failure in adult renal transplant patients (11,(13)(14)(15). Serum phosphorus levels above recommended targets were associated with a higher risk of graft loss, even after adjustment for eGFR.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, in children (8) and adult patients with early (9) or advanced CKD (10), serum phosphorus was independently associated with a decline in renal function. Moreover, donor (11), pretransplant (12,13), and post-transplant (14-16) mineral levels have been associated with graft failure in adult renal graft recipients. Information on mineral metabolism in pediatric graft recipients mainly originates from small single-center studies with relatively short follow-up time (5,17,18).…”

Section: Introductionmentioning

confidence: 99%

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Mineral Metabolism in European Children Living with a Renal Transplant

Bonthuis¹,

Busutti²,

Stralen³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Data on mineral metabolism in pediatric renal transplant recipients largely arise from small single-center studies. In adult patients, abnormal mineral levels are related to a higher risk of graft failure. This study used data from the European Society for Paediatric Nephrology/European Renal AssociationEuropean Dialysis and Transplant Association Registry to study the prevalence and potential determinants of mineral abnormalities, as well as the predictive value of a disturbed mineral level on graft survival in a large cohort of European pediatric renal transplant recipients.Design, setting, participants, & measurements This study included 1237 children (0-17 years) from 10 European countries, who had serum calcium, phosphorus, and parathyroid hormone measurements from 2000 onward. Abnormalities of mineral metabolism were defined according to European guidelines on prevention and treatment of renal osteodystrophy in children on chronic renal failure.Results Abnormal serum phosphorus levels were observed in 25% (14% hypophosphatemia and 11% hyperphosphatemia), altered serum calcium in 30% (19% hypocalcemia, 11% hypercalcemia), and hyperparathyroidism in 41% of the patients. A longer time since transplantation was associated with a lower risk of having mineral levels above target range. Serum phosphorus levels were inversely associated with eGFR, and levels above the recommended targets were associated with a higher risk of graft failure independently of eGFR.Conclusions Abnormalities in mineral metabolism are common after pediatric renal transplantation in Europe and are associated with graft dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mineral Metabolism in European Children Living with a Renal Transplant

Bonthuis¹,

Busutti²,

Stralen³

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…The effect of pretransplant recipients' serum phosphorus level on transplant outcomes is un-clear; however, a recent study showed in living kidney donor transplants that a higher donor phosphorus level was an independent risk factor for early allograft dysfunction (24). We sought to examine the association of pretransplant serum phosphorus levels with all-cause and CVD mortality, graft failure, and delayed graft function (DGF) in a U.S.-based renal transplant population and we hypothesized that higher phosphorus levels are incrementally associated with poor graft and patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Association of Pretransplant Serum Phosphorus with Posttransplant Outcomes

Sampaio

Molnar

Kövesdy

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Serum phosphorus levels are associated with mortality, cardiovascular disease, and renal function loss in individuals with and without chronic kidney disease. The association of pretransplant serum phosphorus levels with transplant outcomes is not clear. The selected 9384 primary kidney recipients were divided into five groups according to pretransplant serum phosphorus levels (mg/dl): Ͻ3.5, 3.5 to Ͻ5.5 (reference group), 5.5 to Ͻ7.5, 7.5 to Ͻ9.5, and Ն9.5. Unadjusted and multivariate adjusted risks for transplant outcomes were compared. ResultsPatients were 48 Ϯ 14 years old and included 37% women and 27% African Americans. After multivariate adjustment, all-cause and cardiovascular death hazard ratios were 2.44 (95% confidence interval: 1.28 to 4.65) and 3.63 (1.13 to 11.64), respectively, in recipients in the Ն9.5 group; allograft loss hazard ratios were 1.42 (1.04 to 1.95) and 2.36 (1.33 to 4.17) in recipients with 7.5 to Ͼ9.5 and Ն9.5, respectively. No significant association with delayed graft function was found.Conclusions Pretransplant phosphorus levels 7.5 to Ͻ9.5 mg/dl and Ն9.5 mg/dl were associated with increased risk of functional graft failure and increased risk of all-cause and cardiovascular deaths, respectively, when compared with 3.5 to Ͻ5.5 mg/dl. Additional studies are needed to examine whether more aggressive control of pretransplant serum phosphorus may improve posttransplant outcomes.

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“…59 Chang and associates indicated that DGF or slow graft function after transplant is independently correlated with higher donor phosphorus levels. 60 Clinical issues like the duration between radiologic renal observation and transplant also modulate the risk of DGF incidence. Tutal and associates reported that DGF was observed in a greater number of patients undergoing early transplant (≤ 20 d; n = 42) than late transplant (≥ 20 d; n = 38) after renal angiography (22.0% vs 2.6%; P = .009).…”

Section: Other Risk Factorsmentioning

confidence: 99%

Untitled

2016

Exp Clin Transplant

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With an increased incidence of living-donor kidney transplants, in response to increasing unmet needs for renal transplant, a clear understanding of determinants of posttransplant outcomes is essential. The importance of delayed graft function in deceased-donor kidney transplant is now part of conventional medical wisdom, due to the large amount of evidence focused on this aspect. However, the same is not true for living-donor kidney transplant, partly due to lack of evidence on this crucial clinical question and partly due to lack of awareness about this issue. The current review aims to highlight the importance of delayed graft function as a crucial determinant of outcomes in living-donor kidney transplant. An exhaustive search of online medical databases was performed with appropriate search criteria to collect evidence about delayed graft function after living-donor kidney transplant, with a special focus on studies from the Middle East. Data on incidence, impact, risk factors, and possible prevention modalities of delayed graft function in patients undergoing living-donor kidney transplant are presented. A key finding of this review is that contemporary incidence rates reported from the Middle East are comparatively higher than those reported from outside the region. Although in absolute terms the incidence is lower than deceaseddonor kidney transplant, the effects of delayed graft function on graft rejection and graft and patient survival are sufficiently large to warrant the formulation of specific treatment protocols. Key to formulating prevention and treatment strategies is identifying discrete risk factors for delayed graft function. Although this evidence is scant, an overview has been provided. Further studies examining different aspects of delayed graft function incidence after living-donor kidney transplant are urgently needed to address a so far little known clinical question.

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Donor Phosphorus Levels and Recipient Outcomes in Living-Donor Kidney Transplantation

Cited by 4 publications

References 29 publications

Mineral Metabolism in European Children Living with a Renal Transplant

Mineral Metabolism in European Children Living with a Renal Transplant

Association of Pretransplant Serum Phosphorus with Posttransplant Outcomes

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