Outcome and Challenges of Kidney Transplant in Patients with Sickle Cell Disease

Okafor, Umezurike Hughes; Aneke, E

doi:10.1155/2013/614610

Cited by 16 publications

(10 citation statements)

References 47 publications

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“…They range from haematuria, varying degrees of proteinuria and renal failure syndromes to glomerular and tubular abnormalities [5,6] which may ultimately progress to chronic kidney disease (CKD) [7,8]. End-stage kidney disease has been identified as the most severe presentation of SCN, with a huge impact on morbidity and mortality, making early identification and management important [9]. …”

Section: Introductionmentioning

confidence: 99%

Degrees of Kidney Disease in Nigerian Adults with Sickle-Cell Disease

Aneke

Adegoke²,

Oyekunle³

et al. 2014

Med Princ Pract

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Objective: To study degrees of chronic kidney disease (CKD) using creatinine clearance in adult Nigerian patients with sickle-cell disease (SCD). Methods: One hundred SCD patients, made up of 79 HbSS (homozygous haemoglobin S) patients and 21 HbSC (heterozygous haemoglobins S and C) patients, were investigated prospectively, along with 50 normal controls. Their sociodemographic data, weight and drug history were documented. Each participant underwent dipstick urinalysis, and creatinine clearance was calculated following a 24-hour urine collection and serum creatinine measurement. They were categorized into stages of CKD based on the creatinine clearance. Results: Of the 79 HbSS patients, 14 (18%), 28 (35%), 33 (42%) and 4 (5%) had stage 1, 2, 3 and 4 CKD, respectively. In the HbSC group, 3 (14%), 9 (43%) and 9 (43%) patients had stage 1, 2 and 3 CKD, respectively. Proteinuria was noted in 16 (20%) HbSS patients but not in any of the HbSC patients. Of the subjects aged ≤24 years (n = 49), 9 (18%), 18 (37%), 21 (43%) and 1 (2%) had stage 1, 2, 3 and 4 CKD, respectively. Of those aged >24 years (n = 51), 8 (16%), 19 (37%), 21 (41%) and 3 (6%) had stage 1, 2, 3 and 4 CKD, respectively. None of the subjects had stage 5 CKD. Conclusion: In this study, the adult subjects with SCD had various degrees of CKD. Adequate follow-up and active intervention are advocated to delay the onset of end-stage nephropathy.

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Section: Introductionmentioning

confidence: 99%

Degrees of Kidney Disease in Nigerian Adults with Sickle-Cell Disease

Aneke

Adegoke²,

Oyekunle³

et al. 2014

Med Princ Pract

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“…Finally, there are limited data on emerging treatments for SCD in the OPTN/UNOS database. Bone marrow transplantation has recently emerged as a novel treatment for SCD [ 49 ], and the beneficial effects of bone marrow transplantation in improving target organ damage have been reported [ 12 , 50 , 51 ]. Nevertheless, successful bone marrow transplant has only been reported in a limited number of dialysis and kidney transplant patients with SCD [ 50 , 52 , 53 ].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, successful bone marrow transplant has only been reported in a limited number of dialysis and kidney transplant patients with SCD [ 50 , 52 , 53 ]. Additional studies are needed to assess its potential effects on clinical outcomes of SCD kidney transplant recipients [ 12 ]. In addition, while genetic approaches against SCD such as CRISPR gene correction therapy are promising, investigation in this area is still in the early stages [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ongoing unequal access to kidney transplantation for SCD is a reflection of the transplant community’s concerns related to increased mortality risk for SCD patients compared to ESKD patients from other causes [ 11 , 12 ]. Nonetheless, despite having an increased risk, SCD ESKD patients receive a survival benefit following kidney transplantation similar to non-SCD ESKD patients [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Kidney Transplant Recipients with Sickle Cell Disease: An Analysis of the 2000–2019 UNOS/OPTN Database

Leeaphorn

Vaitla

Hansrivijit

et al. 2021

JCM

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Background: Lower patient survival has been observed in sickle cell disease (SCD) patients who go on to receive a kidney transplant. This study aimed to assess the post-transplant outcomes of SCD kidney transplant recipients in the contemporary era. Methods: We used the OPTN/UNOS database to identify first-time kidney transplant recipients from 2010 through 2019. We compared patient and allograft survival between recipients with SCD (n = 105) vs. all other diagnoses (non-SCD, n = 146,325) as the reported cause of end-stage kidney disease. We examined whether post-transplant outcomes improved among SCD in the recent era (2010–2019), compared to the early era (2000–2009). Results: After adjusting for differences in baseline characteristics, SCD was significantly associated with lower patient survival (HR 2.87; 95% CI 1.75–4.68) and death-censored graft survival (HR 1.98; 95% CI 1.30–3.01), compared to non-SCD recipients. The lower patient survival and death-censored graft survival in SCD recipients were consistently observed in comparison to outcomes of recipients with diabetes, glomerular disease, and hypertension as the cause of end-stage kidney disease. There was no significant difference in death censored graft survival (HR 0.99; 95% CI 0.51–1.73, p = 0.98) and patient survival (HR 0.93; 95% CI 0.50–1.74, p = 0.82) of SCD recipients in the recent versus early era. Conclusions: Patient and allograft survival in SCD kidney recipients were worse than recipients with other diagnoses. Overall SCD patient and allograft outcomes in the recent era did not improve from the early era. The findings of our study should not discourage kidney transplantation for ESKD patients with SCD due to a known survival benefit of transplantation compared with remaining on dialysis. Urgent future studies are needed to identify strategies to improve patient and allograft survival in SCD kidney recipients. In addition, it may be reasonable to assign risk adjustment for SCD patients.

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“…Complications specific to the SCD population include higher infection risk due to autosplenectomy and precipitation of sickle cell crises with anemia correction following a successful transplant. Kidney transplant may be also complicated by allograft venous thrombosis, deep vein thrombosis, and vaso-occlusive crises [63,161,162]. Suggested maneuvers to decrease the incidence of post-transplant complications in these patients include [63,163] preoperative blood transfusions to decrease hemoglobin S levels, preoperative oxygen supplementation with 40% oxygen, pretransplantation warming of the kidney allograft using 37 o C saline, intraoperative and postoperative dopamine infusion at 4 μg/kg/min stem cell transplantation remain as the only curative treatment with good result and survival rates around 90% in 4 years [164,165].…”

Section: Treatment Of End-stage Renal Diseasementioning

confidence: 99%

Sickle Cell Nephropathy: Current Understanding of the Presentation, Diagnostic and Therapeutic Challenges

Inusa¹,

Lodi²,

Palazzi³

et al. 2018

Hematology - Latest Research and Clinical Advances

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Sickle cell nephopathy (SCN) begins early in childhood from failure of urinary concentration (hyposthenuria), albuminuria to hyperfiltration, hematuria and progression to falling glomerular filtration to end-stage renal disease and increased mortality. Renal involvement is more severe in homozygous individuals (HbSS) than in compound heterozygous patients (HbSC). The pathogenesis of SCN is multifactorial from hypoxia, acidosis, hemolysis, ischemia-reperfusion injury and albuminuria. The clinical manifestations depend on whether the main pathology is tubular, glomerular or a mixture of both abnormalities. This chapter offers a critical review of the recent literature and will highlight the pathophysiology, epidemiology, clinical manifestations and management of sickle cell nephropathy with particular focus on the major advance in the early diagnosis. Learning points: For SCN, the onset of hyperfiltration and albuminuria in infants and childhood is an opportunity to intervene early. There is no diagnostic markertest capable of detecting the onset of these changes. Moreover there is no reliable therapeutic agent to prevent or halt early changes due to SCN. The development of a marker of renal impairment in SCD such as such as Cystatin C assay if validated may be appropriate for wider clinical application.

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Outcome and Challenges of Kidney Transplant in Patients with Sickle Cell Disease

Cited by 16 publications

References 47 publications

Degrees of Kidney Disease in Nigerian Adults with Sickle-Cell Disease

Degrees of Kidney Disease in Nigerian Adults with Sickle-Cell Disease

Outcomes of Kidney Transplant Recipients with Sickle Cell Disease: An Analysis of the 2000–2019 UNOS/OPTN Database

Sickle Cell Nephropathy: Current Understanding of the Presentation, Diagnostic and Therapeutic Challenges

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