Causes of death after renal transplantation

Briggs, J. D.

doi:10.1093/ndt/16.8.1545

Cited by 311 publications

(246 citation statements)

References 17 publications

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“…Dialysis is the most common treatment for ESRD, while kidney transplantation is the most ideal treatment. However, dialysis and transplantation have adverse effects, including cardiovascular disease, infection and cancer (2,3). In addition, cancer is increasingly recognized as a complication and a major cause of mortality in patients with ESRD receiving renal replacement therapy (RRT) (4).…”

Section: Introductionmentioning

confidence: 99%

Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

Shi

Huang

et al. 2016

Molecular and Clinical Oncology

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Abstract. It has been reported that patients receiving renal replacement therapy (RRT), including dialysis and kidney transplantation, tend to have an increased risk of cancer; however, studies on the degree of this risk have remained inconclusive. The present meta-analysis was therefore performed to quantify the cancer risk in patients with RRT. Cohort studies assessing overall cancer risk in RRT patients published before May 29, 2015 were included following systematic searches with of PubMed, EMBASE and the reference lists of the studies retrieved. Random-effects meta-analyses were used to pool standardized incidence rates (SIRs) with 95% confidence intervals (CIs). Heterogeneity tests, sensitivity analyses and publication bias assessment were performed. A total of 18 studies including 22 cohort studies were eventually identified, which comprised a total of 1,528,719 patients. In comparison with the general population, the pooled SIR for patients with dialysis including non-melanoma skin cancer (NMSC), dialysis excluding NMSC, transplantation including NMSC, transplantation excluding NMSC and RRT were 1.40 (95% CI, 1.36-1.45), 1.35 (95% CI, 1.23-1.50), 3.26 (95% CI, 2.29-4.63), 2.08 (95% CI, 1.73-2.50) and 2.01 (95% CI, 1.70-2.38), respectively. The cancer risk was particularly high in subgroups of large sample size trials, female patients, younger patients (age at first dialysis, 0-34 years; age at transplantation, 0-20 years), the first year of RRT and non-Asian transplant patients. A significant association was also found between RRT and the majority of organ-specific cancers. However, neither dialysis nor transplantation was associated with breast, body of uterus, colorectal or prostate cancer. Significant heterogeneity was found regarding the association between RRT and overall cancer as well as the majority of site-specific cancer types. However, this heterogeneity had no substantial influence on the pooled SIR for overall cancer in RRT according to the sensitivity analysis. Compared with the general population, RRT patients have a significantly increased risk of overall cancer and the majority of specific cancer types, particularly Kaposi sarcoma (KS), lip cancer and NMSC in patients subjected to kidney transplantation and cancer of the thyroid gland and kidney as well as myeloma in dialysis patients. Considering the high heterogeneity encountered, further high-quality studies are required.

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Section: Introductionmentioning

confidence: 99%

Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

Shi

Huang

et al. 2016

Molecular and Clinical Oncology

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“…[3] The main contributing factors leading to atheroma include older age, male gender, hyperlipidemia, smoking, obesity, lack of exercise, hyperglycemia, and hyperhomocysteinanemia. [4] Though renal transplantation eliminates cardiovascular disease risk factors by restoring renal function, it introduces new cardiovascular risks, derived in part from immunosuppressive medications. [1] Immunosuppressive therapy necessary to avoid premature graft loss may also increase the tendency to atheroma.…”

Section: Introductionmentioning

confidence: 99%

Effects of Immunosuppressive Drugs on Platelet Aggregation and Soluble P-Selectin Levels in Renal Transplant Patients

et al. 2009

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Background/aim. Post-transplant cardiovascular events are associated with increased morbidity and mortality after renal transplantation. Though renal transplantation eliminates cardiovascular disease risk factors by restoring renal function, it introduces new cardiovascular risks derived partly from immunosuppressive medications. In this study, to assess the effects of various immunosuppressive drugs on platelet function of renal transplant patients, we measured soluble P selectin levels (sP-selectin) and performed platelet aggregation studies in patients who have undergone renal transplantation. Methods. sP-selectin levels and platelet aggregation induced by 5 μM adenosine diphosphate (ADP), 5 μM epinephrine, 1.25 mg/mL ristocetin, and 2 μg/mL collagen were studied by whole blood platelet lumiaggregometer in 40 renal transplant patients. Patients in group 1 (n = 24) were treated with cyclosporine/mycophenolate mofetil/ methylprednisolone, and group 2 (n = 16) were treated with tacrolimus/mycophenolate mofetil/methylprednisolone. Effects were compared with those in control groups of hypertensive subjects and healthy subjects. Results. Platelet aggregation values induced by ADP, epinephrine, ristocetin, and collagen were lower in cyclosporine-treated patients than tacrolimus-treated patients, hypertensive subjects, and healthy subjects, though the difference was not statistically significant (p > 0.05). sP-selectin levels were appreciably higher in cyclosporine-treated patients, and statistically significant differences were observed compared with those of tacrolimus-treated patients (p < 0.05), hypertensive subjects (p < 0.01), and healthy subjects (p < 0.05). Conclusion. We conclude that cyclosporine-treated renal transplant patients show enhanced platelet activation in which anti-platelet therapy should be considered, in addition to management of other conventional cardiovascular risk factors, to decrease the cardiovascular morbidity and mortality in this high risk population.

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“…This survival benefit is largely attributable to a decrease in cardiovascular events within the first year post-transplant. 30 Thus, although it is important to recognize that HCVinfected kidney recipients have an increased hazard ratio for death, transplant continues to offer these patients a significantly improved survival compared with remaining on dialysis. [25][26][27][28][29]31 HCV and KT HCV infection is the primary cause of liver disease in KT recipients 32 ; however, it has also been associated with important extrahepatic manifestations that contribute to increased morbidity and mortality after transplantation.…”

Section: Hcv In Patients With Kidney Diseasementioning

confidence: 99%

Hepatitis C Virus Infection in Chronic Kidney Disease

Ladino

Pedraza

Roth

2016

JASN

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Soon after the hepatitis C virus (HCV) was identified in 1989, it was recognized that the prevalence of infection in patients with ESRD far exceeded that in the general population. Infection with HCV predisposes to the hepatic complications of cirrhosis and hepatocellular carcinoma. However, important extrahepatic manifestations include immune complex glomerular disease, accelerated progression of CKD, increases in cardiovascular event risk, and lymphoproliferative disorders. Advances in understanding the molecular biology of HCV have ushered in a new era in the treatment of this infection. Second generation direct-acting antiviral agents have revolutionized therapy, with sustained virologic response rates (undetectable viral load 12 weeks after completing therapy) of .90% in most patients. Studies using direct-acting antivirals in patients with CKD and those on dialysis are showing excellent safety and efficacy as well. In this context, it is imperative that nephrologists become familiar with this literature, reviewed here, so that the important decisions, including which patients should be treated and the optimal timing to initiate therapy, are vetted in association with the compounding issues of CKD, ESRD, and kidney transplantation.

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Causes of death after renal transplantation

Cited by 311 publications

References 17 publications

Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

Effects of Immunosuppressive Drugs on Platelet Aggregation and Soluble P-Selectin Levels in Renal Transplant Patients

Hepatitis C Virus Infection in Chronic Kidney Disease

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