Predictors of renal function following lung or heart-lung transplantation

Ishani, Areef; Ertürk, Şehsuvar; Hertz, Marshall I.; Matas, Arthur J.; Savik, Kay; Rosenberg, Mark E.

doi:10.1046/j.1523-1755.2002.00361.x

Cited by 103 publications

(90 citation statements)

References 31 publications

(4 reference statements)

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“…CKD and ESKD are extremely important outcomesafter SOT, leading tonumerous (15) 1137 (13) 900 (16) 191 (20) 267 (28) 48 ( (24) 1436 (18) 1255 (25) 390 (44) 370 (44) 84 (55) 5-y mortality, n (%) c 4091 (30) 1585 (22) 1507 (34) 495 (60) med, median. a 1-y mortality reported for all subjects, as all subjects were eligible for at least 1 y of follow-up time.…”

Section: Discussionmentioning

confidence: 99%

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End-Stage Kidney Disease After Pediatric Nonrenal Solid Organ Transplantation

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: End-stage kidney disease (ESKD) causes significant morbidity and mortality after solid organ transplantation. Adults commonly develop advanced kidney disease, particularly after liver and intestinal transplantation. Previous pediatric studies have not compared the relative incidence of ESKD by organ type. WHAT THIS STUDY ADDS:This national cohort study shows the highest risk of ESKD among pediatric lung and intestinal transplant recipients, reflecting unique organ-specific causes of kidney injury. Our findings have implications for screening for and treating early kidney disease in transplant recipients. abstract OBJECTIVES: Adult solid organ transplant (SOT) recipients commonly develop advanced kidney disease; however, the burden of end-stage kidney disease (ESKD) in children after SOT is not well-described. The objectives of this study were to determine the incidence of ESKD after pediatric SOT and the relative risk by SOT type. METHODS:Retrospective multicenter cohort study of children, ages #18 years, who received SOTs from 1990 through 2010 using Scientific Registry of Transplant Recipients data linked to the US Renal Data System. We performed a competing risks analysis to determine cumulative incidence of ESKD (chronic dialysis or kidney transplant), treating death as a competing risk, and fit a multivariable Cox regression model to assess hazard of ESKD by organ type. RESULTS:The cohort included 16 604 pediatric SOT recipients (54% liver, 34% heart, 6% lung, 6% intestine, and 1% heart-lung). During a median follow-up of 6.2 years (interquartile range 2.2-12.1), 426 (3%) children developed ESKD. Compared with liver transplant recipients, in whom the incidence of ESKD was 2.1 cases per 1000 person-years, in adjusted analyses the highest risk of ESKD was among intestinal (hazard ratio [HR] 7.37, P , .001), followed by lung (HR 5.79, P , .001) and heart transplant recipients (HR 1.79, P , .001). CONCLUSIONS:In a 20-year national cohort of pediatric SOT recipients, the risk of ESKD was highest among intestinal and lung transplant recipients. The burden of earlier stages of chronic kidney disease is probably much higher; modifiable risk factors should be targeted to prevent progressive kidney damage in this high-risk population.

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Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12][13][14][15][16] The risk of ESKD in adult SOT recipients varies by organ transplanted. 4 This variability may be explained by differences in the burden of baseline comorbidities, variations in intensity of immunosuppressive regimens, and distinct rates of peritransplant AKI.…”

mentioning

confidence: 99%

End-Stage Kidney Disease After Pediatric Nonrenal Solid Organ Transplantation

et al. 2013

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“…Clinical variables for allograft dysfunction were defined based on predisposing factors to AKI and the ECD (33). Renal function was analyzed as the reciprocal of serum creatinine (1/Cr) (34). Clinical risk scores for evaluation of the early dysfunction of DBD kidneys included KDRI (11), the Web-based DGF risk calculator program by Irish et al (14), and the equation developed by Schold et al (12).…”

Section: Clinical Assessment Of Kidney Allograftsmentioning

confidence: 99%

Comparing Molecular Assessment of Implantation Biopsies With Histologic and Demographic Risk Assessment

Kreepala

Famulski

Chang

et al. 2013

American Journal of Transplantation

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We hypothesized that measurement of previously defined acute kidney injury-induced transcripts at the time of implantation would add a new dimension to existing methods based on donor factors, histology and recipient factors. We analyzed microarray results from implantation biopsies taken after reperfusion from 70 kidneys from 53 deceased donors. We used two definitions of early dysfunction: serum creatinine > 265 umol/L at day 7 posttransplant; and dialysis in the first week. The strongest correlate with early dysfunction was the mean expression of 30 injury transcripts. Older donor and recipient age were associated with early dysfunction, but histologic lesions were not. Prediction was best when the injury transcript expression was combined with donor or recipient age, particularly in standard criteria donors. In contrast, although extended criteria donor kidneys had a high risk of early dysfunction, no variables tested, including injury transcripts, predicted risk significantly, probably because these kidneys were allocated preferentially to old, high risk recipients. The injury transcripts did not predict late function, which was mainly associated with donor age. Thus, measurement of injury-induced transcripts at the time of implantation improves the prediction of early kidney dysfunction, but risk prediction may fail when old kidneys are transplanted into old recipients.

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“…1,[5][6][7][8] This wide range is partly explained by a lack of consensus criteria as to what constitutes CKD in these populations and by shortcomings of estimating equations that depend on serum creatinine. 9 Transplant candidates and recipients often have lower muscle mass and less creatinine generation than the populations in which these equations were developed, limiting the accuracy of the equations.…”

Section: Prevalence Of Ckd After Nonrenal Organ Transplantationmentioning

confidence: 99%

“…Reliance on serum creatinine alone typically leads to an overestimation of renal function in patients before transplantation, particularly in those with poor nutritional status, low muscle mass, weight loss, and edema. 5,14 Kidney function in patients who are awaiting nonrenal transplantation is frequently compromised by poor effective circulating volume (e.g., low cardiac output in advanced heart failure, hepatorenal syndrome in liver candidates) that is not always reversible after successful placement of a functioning organ ( Figure 1). 2,15 For instance, in a retrospective cohort study of heart recipients, more than one third of patients had stage 3 or worse CKD before transplantation.…”

Section: Renal Function Before Transplantationmentioning

confidence: 99%