Posttransplantation chronic renal damage in nonrenal transplant recipients

Stratta, Piero; Canavese, Caterina; Quaglia, Marco; Balzola, F.; Bobbio, Marco; Busca, Alessandro; Franchello, A; Libertucci, Daniela; Mazzucco, Gianna

doi:10.1111/j.1523-1755.2005.00558.x

Cited by 50 publications

(32 citation statements)

References 82 publications

(100 reference statements)

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“…Renal dysfunction is common after liver transplantation [22][23][24][25] , and it has been reported to be associated with high levels of CNI [26] . ADV contributed to the elevation of plasma tacrolimus levels in this patient, and this elevation may have been associated with his renal dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Development of osteomalacia in a post-liver transplant patient receiving adefovir dipivoxil

Minemura

Tokimitsu²,

Tajiri³

et al. 2010

WJH

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We report the case of a patient treated with living do norrelated liver transplantation who suffered from osteomalacia during adefovir dipivoxil (ADV)containing antiviral therapy for lamivudineresistant hepatitis B virus infection. The patient had generalized bone pain, with severe hypophosphatemia after 20 mo of ADV therapy. Radiographic studies demonstrated the presence of osteomalacia. The peak plasma ADV level was 38 ng/mL after administration of ADV at 10mg/day. It was also found that ADV affected the metabolism of tacrolimus, a calcineurininhibitor, and caused an increase in the plasma levels of tacrolimus. The disability was reversed with the withdrawal of ADV and with mineral supplementation. ADV can cause an elevation of plasma tacrolimus levels, which may be associated with renal dysfunction. High levels of ADV and tacrolimus can cause nephrotoxicity and osteomalacia. This case highlights the importance of considering a diagnosis of osteomalacia in liver transplantation recipients treated with both ADV and tacrolimus.

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Section: Discussionmentioning

confidence: 99%

Development of osteomalacia in a post-liver transplant patient receiving adefovir dipivoxil

Minemura

Tokimitsu²,

Tajiri³

et al. 2010

WJH

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“…Renal failure in these patients has been found to be a major risk factor for patient survival, mainly after heart and lung transplantation (4,6,7,14,(20)(21)(22)(23). Calcineurin- (24)(25)(26)(27).…”

Section: Transplanted Kidneys Fail After Years For Various Poorly Defmentioning

confidence: 99%

Biopsy‐Diagnosed Renal Disease in Patients After Transplantation of Other Organs and Tissues

Schwarz¹,

Haller²,

Schmitt³

et al. 2010

American Journal of Transplantation

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Renal function deteriorates in about half of patients undergoing other transplants. We report the results of 105 renal biopsies from 101 nonrenal transplant recipients (bone marrow 14, liver 41, lung 30, heart 20). Biopsy indications were protracted acute renal failure (9%), creatinine increases (83%), heavy proteinuria (22%), or renal insufficiency before re-transplantation (9%). Histological findings other than nonspecific chronic changes, hypertension-related damage, and signs of chronic CNI toxicity included primary glomerular disease (17%), mostly after liver transplantation (21%) or after bone marrow transplantation (29%), and thrombotic microangiopathy (TMA) namely (10%). TMA had the most serious impact on the clinical course. Besides severe hypertension, one TMA patient died of cerebral hemorrhage, 5 had hemolyticuremic syndrome, and 6 rapidly developed end-stage renal failure. TMA patients had the shortest kidney survival post-biopsy and, together with patients with acute tubular injury, the shortest kidney and patient survival since transplantation. Nine TMA patients had received CNI, 3 of them concomitantly received an mTOR-inhibitor. CNI toxicity is implicated in most patients with renal failure after transplant of other organs and may play a role in the development of TMA, the most serious complication. However, decreased renal function should not be routinely ascribed to CNI.

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“…It is likely that the same process is even more pronounced among kidney transplant recipients, but even with a biopsy, it may be difficult to ascertain whether the kidney scarring is from CNI toxicity, "chronic rejection," or recurrent disease. A recent review demonstrated the difficulties in ascertaining the extent to which CNI-mediated nephrotoxicity accelerates the deterioration of renal function in these patients (13).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, Gonwa et al (19) reported an incidence of CKD of 8.6% and ESRD of 9.5% at 13 yr in 1727 liver transplants that were performed in 1563 patients. Clearly, development of ESRD after nonrenal transplantation represents a complex interplay among multiple preoperative, intraoperative, postoperative, and long-term risk factors (13).…”

Section: Discussionmentioning

confidence: 99%

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

Chandrakantan

Mattos

Naftel

et al. 2006

Clinical Journal of the American Society of Nephrology

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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.

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Posttransplantation chronic renal damage in nonrenal transplant recipients

Cited by 50 publications

References 82 publications

Development of osteomalacia in a post-liver transplant patient receiving adefovir dipivoxil

Development of osteomalacia in a post-liver transplant patient receiving adefovir dipivoxil

Biopsy‐Diagnosed Renal Disease in Patients After Transplantation of Other Organs and Tissues

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

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