Kidney transplantation in patients with systemic sclerosis: a nationwide multicentre study

Bertrand, Dominique; Dehay, Julien; Ott, Julien; Sberro, Rebecca; Brunelle, Charlotte; Kamar, Nassim; Colosio, Charlotte; Châtelet, Valérie; Albano, Laetitia; Girerd, Sophie; Audard, Vincent; Barbet, Christelle; Dantal, Jacques; Ducloux, Didier; Dürrbach, Antoine; Garrigue, Valérie; Hazzan, Marc; Heng, Anne-Élisabeth; Mariat, Christophe; Merville, Pierre; Rérolle, Jean-Philippe; Moulin, Anne‐Marie; Guerrot, Dominique

doi:10.1111/tri.12923

Cited by 31 publications

(49 citation statements)

References 25 publications

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“…Older studies reported bad outcome of SSc patients after kidney transplant compared to patients with other causes of kidney failure. However, recent studies have shown excellent patient and graft survival [52].…”

Section: Acute Kidney Injurymentioning

confidence: 99%

“…Both recurrence of SRC after kidney transplantation and graft loss due to SRC recurrence have been reported. Recurrence rate is fortunately low (8.8%) and patients after kidney transplant should be monitored similarly to patients with SSc at high risk of SRC development [52].…”

Section: Acute Kidney Injurymentioning

confidence: 99%

“…Most patients were treated with high-dose steroids at the time of transplantation followed by long-term low doses in combination with calcineurin inhibitors and mycophenolate mofetil. A significant number of patients were weaned from steroids with reasonable outcome, but recommendations cannot be made due to limited number of patients [52].…”

Section: Acute Kidney Injurymentioning

confidence: 99%

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Renal Involvement in Systemic Sclerosis

Soukup¹,

Toms²,

Oreská³

et al. 2019

New Insights Into Systemic Sclerosis [Working Title]

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Scleroderma renal crisis (SRC) is classical renal disease in systemic sclerosis (SSc). SRC is a relatively rare manifestation, approximately in 5% of patients. In terms of severity, manifestation in the form of SRC is the most common cause of acute organ failure. In SSc patients, SRC is defined as a new onset of accelerated arterial hypertension and rapidly progressive anuric or oliguric renal failure. SRC is primarily vascular injury with increased activity of the renin-angiotensin activity. These events lead to release or activation of cytokines and growth factors that result in the typical proliferative vascular lesions. Successful approach is routine use of angiotensin-converting enzyme inhibitors in the treatment of SRC (except prevention) and other advances in renal replacement therapy in SSc management. It is crucial to detect manifestations of SRC early and to manage appropriately in collaboration with intensive care medicine, cardiologists, and nephrologists. In contrast to SRC, clinical presentation of interstitial renal disease is poor, often without evidence of renal abnormality. Interestingly, other renal manifestations are glomerulonephritis and vasculitis. These manifestations are associated with overlapping mechanisms. The objective of this chapter is to focus on actual knowledge about the renal involvement in SSc and current treatment principles and possibilities.

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Section: Acute Kidney Injurymentioning

confidence: 99%

Section: Acute Kidney Injurymentioning

confidence: 99%

Section: Acute Kidney Injurymentioning

confidence: 99%

See 1 more Smart Citation

Renal Involvement in Systemic Sclerosis

Soukup¹,

Toms²,

Oreská³

et al. 2019

New Insights Into Systemic Sclerosis [Working Title]

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“…Previously, kidney transplantation in SSc patients had been reported to have poorer patient and graft survival rates than in other primary renal diseases [11]. On the other hand, recently, one report suggested no inferior prognosis under the circumstances of well-controlled pulmonary parenchymal involvement [12]. Another report suggested that patients with SSc are more likely to recover from ESRD than other nephrotoxic diseases over a year.…”

Section: Discussionmentioning

confidence: 99%

Kidney failure after lung transplantation in systemic scleroderma: a case report with literature review

et al. 2020

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Background Systemic scleroderma (SSc) involves multiple organs including the skin, the lung, the kidney, and the esophagus. Nowadays, patient life prognosis has substantially improved due to more appropriate management of lung complications, including lung transplantation. However, the extension of their survival may increase SSc patients with chronic kidney diseases and requiring renal replacement therapy (RRT). Case presentation A 51-year-old female with SSc who underwent unilateral deceased-donor lung transplantation was referred because of progressive renal dysfunction. Despite no episodes of scleroderma renal crisis, her renal function gradually deteriorated for 2 years with her serum creatinine level increasing from 0.5 mg/dL at transplantation to 4.3 mg/dL. Although we reinforced antihypertensive treatment and reduced calcineurin inhibitor dose, she thereafter developed symptomatic uremia. Due to impaired manual dexterity with contracture of the interphalangeal joints, no caregivers at home, and kidney transplantation donor unavailability, maintenance hemodialysis was chosen as RRT modality. Further, due to the narrowing of superficial vessels in the sclerotic forearm skin and post-transplant immunocompromised status, the native left brachiocephalic arteriovenous fistula was created. Post-operative course was uneventful while any sign of cutaneous infection and pulmonary hypertension was closely monitored. Our literature review also indicates several difficulties with initiating and maintaining RRT in patients with SSc although case reports of kidney failure after lung transplanation in SSc were not accumulated. Conclusions With respect to initiating RRT for post-lung transplant patients with SSc, the clinical course of our case exemplifies recent complex trends of renal management. The optimal modality with secured initiation of RRT should be carefully determined based on the severity and risk for the cardiopulmonary, peripheral vascular, cutaneous, and systemic or local infectious complications.

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“…RRT includes dialysis-hemo-and/or peritoneal-as well as renal transplantation (10). As reported in two other recent publications, one from France (11) and another from the US (12), they found that the incidence of SRC decreased by over 50% between 2002 and 2013, while the prevalence increased by about 10%, suggesting some success of RRT, as well as success in preventing SRC with rapid treatment of SSc-associated malignant hypertension with angiotensin-converting enzyme inhibitors.…”

mentioning

confidence: 85%