Increasing Referral for Renal Transplant Evaluation in Recipients of Nonrenal Solid-Organ Transplants

Abstract

The use of cyclosporine and tacrolimus therapy in nonrenal (heart, heart/lung, lung, and liver) transplantation has resulted in improved patient and graft survival. Nephrotoxicity is one of the major side effects of tacrolimus and cyclosporine therapy and may lead to ESRD. The trend of referral of nonrenal solid-organ transplant recipients for kidney transplant evaluation at a large multiorgan transplant center was examined. Records of all patients who were referred for renal transplantation at the University of Alabama between January 1, 1993, and June 30, 2004, were reviewed. Eighty (0.96%) of 8318 individuals had previously undergone a nonrenal solid-organ transplant and were included in the study. The majority (72%) of patients had their nonrenal transplants performed at the University of Alabama. Twenty-two patients had their nonrenal transplant performed elsewhere and had fewer data available for analysis. From the period 1993-1996 to 2001-2004, an 11-fold increase in the absolute number of referrals of patients with nonrenal transplants was noted. Of patients who were referred for transplant evaluation, 25 became recipients of kidney transplants with a predominance of living-donor transplants. Referral for kidney transplant evaluation among nonrenal solid-organ transplant recipients is increasing and will exacerbate the existing shortage of deceased-donor kidneys that are available for transplantation. There was a trend for liver transplant recipients compared with other solid-organ recipients to develop ESRD at a greater rate.

Predictors of renal function recovery among patients undergoing renal replacement therapy following orthotopic liver transplantation

“…Likewise, a Canadian registry study found significantly decreased survival in post-OLT patients who underwent RRT compared with matched nontransplant chronic dialysis control patients, with 5-year patient survival rates of 17% and 43% for the post-OLT patients and controls, respectively (p = 0.01) [23]. Thus, given the increasing frequency of renal transplant referrals for recipients of nonrenal solid-organ transplants [24], two decisions must be made: the appropriate time to list OLT patients undergoing RRT for a subsequent kidney transplant and whether they should be prioritized for kidney transplantation.…”

Risk of Post-Lung Transplant Renal Dysfunction in Adults With Cystic Fibrosis

“…7 It can also progress to require dialysis and/or kidney transplantation. 13 Most importantly, a posttransplant diagnosis of end-stage chronic renal failure has been shown to be associated with reduced survival. 2,8 To our knowledge, no previous studies have looked at the incidence or predictors of posttransplantation renal dysfunction in the CF population.…”

Outcome of kidney transplant in primary, repeat, and kidney‐after‐nonrenal solid‐organ transplantation: 15‐year analysis of recent UNOS database

“…It is not uncommon that renal failure complicates nonrenal solid‐organ transplantation, leading to a kidney transplant . Improvements in medical care are allowing patients with prior nonrenal solid‐organ transplantation to live longer and to eventually become candidates for kidney transplantation . Renal transplantation after prior nonrenal solid‐organ transplantation has increased over the last 2‐3 decades.…”