Renal Comorbidity After Solid Organ and Stem Cell Transplants
Renal Comorbidity After Solid Organ and Stem Cell Transplants
After transplantation of solid organs or hematopoietic stem cells, a significant acute decrease in renal function occurs in the majority of patients. Depending on the degree of kidney injury, a large number of patients develop chronic kidney disease (CKD) and some develop end-stage renal disease requiring renal replacement therapy. The incidence varies depending on the transplanted organ, but important risk factors for the development of CKD are preexisting renal disease, hepatitis C, diabetes, hypertension, age, sex, posttransplant acute kidney injury and thrombotic microangiopathy. This review article focuses on the risk factors of posttransplant chronic kidney disease after organ transplantation, considering the current literature and integrates the incidence and the associated mortality rates of acute and chronic kidney disease. Furthermore, we introduce the RECAST (REnal Comorbidity After Solid organ and hematopoietic stem cell Transplantation) registry.
Chronic kidney disease after organ transplantation (pTxCKD) is a growing disease entity since patient and transplant survival has significantly improved over the last decades. In a recent article from the Scientific Registry of Transplant Recipients at the University of Michigan Medical School with 69 321 patients with a median follow-up of 36 months, the incidence of pTxCKD was 16.5%. Of these 11 426 patients, 28.9% required chronic dialysis treatment or a secondary renal transplantation. According to the USRDS 2009 annual report, pTxCKD patients represent the fastest growing patient population requiring chronic hemodialysis treatment (http://www.usrds.org). Moreover, the occurrence of pTxCKD has a devastating consequence as the relative risk of death quadruples. This is an excess risk of death considering that posttransplantation cancer is less frequent. This review compares the different organ systems and discusses common and organ specific risk factors for the development of pTxCKD. Considering the wide variety of risk factors (Figure 1), depending on the transplanted organ, we founded the RECAST (REnal Comorbidity After Solid organ and hematopoietic stem cell Transplantation) registry at our transplant center. This prospective monitoring program is intended to identify risk factors that predict the development of acute- and chronic kidney disease and may identify novel targets for therapeutic strategies.
(Enlarge Image)
Figure 1.
Transplantation dependent risk factors leading to acute kidney injury (red) and chronic kidney disease (blue) following liver, heart, lung and bone marrow transplantation, respectively. The RECAST program is expected to confirm the established findings and even discover novel risk factors and marker combinations (with extended proteinuria diagnostics and proteomics) that can predict the development of CKD following transplantation. AKI, acute kidney injury; CKD, chronic kidney disease; CNI, calcineurin inhibitor; GvHD, graft-versus-host disease; IDDM, insulin-dependent diabetes mellitus; SOS, hepatic sinusoidal obstruction syndrome; TBI, dose of total body irradiation.
Abstract and Introduction
Abstract
After transplantation of solid organs or hematopoietic stem cells, a significant acute decrease in renal function occurs in the majority of patients. Depending on the degree of kidney injury, a large number of patients develop chronic kidney disease (CKD) and some develop end-stage renal disease requiring renal replacement therapy. The incidence varies depending on the transplanted organ, but important risk factors for the development of CKD are preexisting renal disease, hepatitis C, diabetes, hypertension, age, sex, posttransplant acute kidney injury and thrombotic microangiopathy. This review article focuses on the risk factors of posttransplant chronic kidney disease after organ transplantation, considering the current literature and integrates the incidence and the associated mortality rates of acute and chronic kidney disease. Furthermore, we introduce the RECAST (REnal Comorbidity After Solid organ and hematopoietic stem cell Transplantation) registry.
Introduction
Chronic kidney disease after organ transplantation (pTxCKD) is a growing disease entity since patient and transplant survival has significantly improved over the last decades. In a recent article from the Scientific Registry of Transplant Recipients at the University of Michigan Medical School with 69 321 patients with a median follow-up of 36 months, the incidence of pTxCKD was 16.5%. Of these 11 426 patients, 28.9% required chronic dialysis treatment or a secondary renal transplantation. According to the USRDS 2009 annual report, pTxCKD patients represent the fastest growing patient population requiring chronic hemodialysis treatment (http://www.usrds.org). Moreover, the occurrence of pTxCKD has a devastating consequence as the relative risk of death quadruples. This is an excess risk of death considering that posttransplantation cancer is less frequent. This review compares the different organ systems and discusses common and organ specific risk factors for the development of pTxCKD. Considering the wide variety of risk factors (Figure 1), depending on the transplanted organ, we founded the RECAST (REnal Comorbidity After Solid organ and hematopoietic stem cell Transplantation) registry at our transplant center. This prospective monitoring program is intended to identify risk factors that predict the development of acute- and chronic kidney disease and may identify novel targets for therapeutic strategies.
(Enlarge Image)
Figure 1.
Transplantation dependent risk factors leading to acute kidney injury (red) and chronic kidney disease (blue) following liver, heart, lung and bone marrow transplantation, respectively. The RECAST program is expected to confirm the established findings and even discover novel risk factors and marker combinations (with extended proteinuria diagnostics and proteomics) that can predict the development of CKD following transplantation. AKI, acute kidney injury; CKD, chronic kidney disease; CNI, calcineurin inhibitor; GvHD, graft-versus-host disease; IDDM, insulin-dependent diabetes mellitus; SOS, hepatic sinusoidal obstruction syndrome; TBI, dose of total body irradiation.
Source...