Improved survival among sickle cell kidney transplant recipients in the recent era

Huang, Edmund; Parke, Chong; Mehrnia, Alireza; Kamgar, Mandana; Pham, Phuong Thu; Danovitch, Gabriel M.; Bunnapradist, Suphamai

doi:10.1093/ndt/gfs585

Cited by 42 publications

(37 citation statements)

References 19 publications

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“…44 Further, although the post-renal-transplantation survival discrepancy still exists between SCD and non-SCD patients with ESRD, the overall mortality for SCD patients posttransplantation has improved and is now comparable with patients with diabetes. 46 Once a patient is listed for renal transplantation, s/he should be started on regular blood transfusion (preferably EBT), which improves their well-being and fitness for surgery while awaiting transplantation. Patients on regular EBT posttransplantation have better graft survival and fewer adverse events, including painful crises and acute sickle nephropathy.…”

Section: Renal Replacement Therapymentioning

confidence: 99%

How I treat renal complications in sickle cell disease

Sharpe

Thein

2014

Blood

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Renal disease is one of the most frequent and severe complications experienced by patients with sickle cell disease; its prevalence is likely to increase as the patient population ages. We recommend regular monitoring for early signs of renal involvement and a low threshold for the use of hydroxyurea as preventative measures for end-stage renal disease. Once renal complications are detected, a careful assessment of the patient is required to rule out other causes of renal disease. Proteinuria and hypertension should be managed aggressively and the patient referred to a specialist nephrology center when progressive decline in renal function is noted. For the few patients who develop advanced chronic kidney disease, timely planning for dialysis and transplantation can significantly improve outcome, and we recommend an exchange blood transfusion policy for all patients on the transplant waiting list and for those with a functioning graft. Alongside the invasive treatment regimes, it is important to remember that renal failure in conjunction with sickle cell disease does carry a significant burden of morbidity and that focusing on symptom control has to be central to good patient care.

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Section: Renal Replacement Therapymentioning

confidence: 99%

How I treat renal complications in sickle cell disease

Sharpe

Thein

2014

Blood

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“…An investigation of outcomes in recipients of renal allografts in the United States revealed that 1-year cadaveric renal allograft survival in recipients with sickle-cell nephropathy was comparable to that in patients with end-stage renal disease from other causes but was significantly poorer at 3 or 6 years. 26,27 Additionally, 6-year survival among recipients with SCD was 71%, compared with 84% for the matched cohort with other diagnoses, and was associated with a 3.42-fold increased risk of death. The etiology of mortality was thought to be mainly due to underlying SCD.…”

Section: Sot In Scdmentioning

confidence: 99%

“…Table 3 lists the publications on SOT for patients with SCD. To date, kidney, [25][26][27] liver, [28][29][30] lung, 31 and combined heart-kidney 32 and liver-kidney 33 transplantations have been reported, with kidney transplantation being the most common. An investigation of outcomes in recipients of renal allografts in the United States revealed that 1-year cadaveric renal allograft survival in recipients with sickle-cell nephropathy was comparable to that in patients with end-stage renal disease from other causes but was significantly poorer at 3 or 6 years.…”

Section: Sot In Scdmentioning

confidence: 99%

“…Huang et al 27 reported that 106 renal transplantations were performed in patients with SCD from 2000 to 2011, and among those, 76.4% received cadaveric allografts and only 25 patients received grafts from living donors. 27 Currently, collecting HSCs from cadavers is problematic; therefore, both HSCs and SOs should ideally come from the same living donor. It is estimated that only 14% to 20% of patients with SCD have unaffected HLA-matched sibling donors.…”

Section: Benefits and Limitations Of Dual Sot And Hsct For Scdmentioning

confidence: 99%

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Toward dual hematopoietic stem-cell transplantation and solid-organ transplantation for sickle-cell disease

Hosoya

Levine

Abt³

et al. 2018

Blood Advances

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Sickle-cell disease (SCD) leads to recurrent vaso-occlusive crises, chronic end-organ damage, and resultant physical, psychological, and social disabilities. Although hematopoietic stem-cell transplantation (HSCT) is potentially curative for SCD, this procedure is associated with well-recognized morbidity and mortality and thus is ideally offered only to patients at high risk of significant complications. However, it is difficult to identify patients at high risk before significant complications have occurred, and once patients experience significant organ damage, they are considered poor candidates for HSCT. In turn, patients who have experienced long-term organ toxicity from SCD such as renal or liver failure may be candidates for solid-organ transplantation (SOT); however, the transplanted organs are at risk of damage by the original disease. Thus, dual HSCT and organ transplantation could simultaneously replace the failing organ and eliminate the underlying disease process. Advances in HSCT conditioning such as reduced-intensity regimens and alternative donor selection may expand both the feasibility of and potential donor pool for transplantation. This review summarizes the current state of HSCT and organ transplantation in SCD and discusses future directions and the clinical feasibility of dual HSCT/SOT.

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“…In a recent study using the Organ Procurement and Transplanting Network/ United Network for Organ Sharing data, investigators showed improvements in 6 year kidney transplant outcomes in recent years (2000-2011) compared to prior years (1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999) with results similar to those seen for patients with diabetes who received transplants. 29 RN is a 22-year-old with hemoglobin SC disease who presents to the ED with SOB and chest pain. She reports that she was studying for her physics final and had been spending lots of time sitting in the library.…”

mentioning

confidence: 99%

The five key things you need to know to manage adult patients with sickle cell disease

Lanzkron¹,

Haywood²

2015

Hematology

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The lack of a strong evidence base to guide the management of adults with sickle cell disease (SCD) makes it difficult for patients to receive high quality care outside of specialty centers. As there is a dearth of providers with sickle cell expertise, the purpose of this article is to identify some of the key things every provider who manages the care of adults with SCD should know. Managing adults with SCD requires excellent clinical skills, as it can affect every organ and cause life-threatening complications but it also requires a willingness to manage patients who often have psychosocial issues that are complex and impact care and care delivery in very significant ways. We have chosen topics for which there is a limited evidence base but which have significant clinical consequences if left unrecognized or poorly managed. The topics that will be addressed include chronic pain, neurocognitive dysfunction, renal disease, venous thromboembolism, and avoiding the inappropriate use of red cell transfusions.

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Improved survival among sickle cell kidney transplant recipients in the recent era

Abstract: Patient survival has improved among contemporary sickle cell recipients compared with an earlier cohort and is comparable to a matched cohort of diabetic kidney recipients. Appropriately selected SCD patients may receive kidney transplants with reasonable survival outcome.

Cited by 42 publications

References 19 publications

How I treat renal complications in sickle cell disease

How I treat renal complications in sickle cell disease

Toward dual hematopoietic stem-cell transplantation and solid-organ transplantation for sickle-cell disease

The five key things you need to know to manage adult patients with sickle cell disease

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