Hypertension and renal dysfunction in long-term liver transplant recipients

Gonwa, Thomas A.

doi:10.1053/jlts.2001.28511

Cited by 52 publications

(37 citation statements)

References 36 publications

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“…[62][63][64] CNIs are important contributors to posttransplantation hypertension, often characterized by a low renin and aldosterone state. 64 Ishani et al 5 demonstrated that diastolic BP elevation is an independent predictor of progressive kidney disease after lung or heart-lung transplantation. This observation is consistent with those in nontransplantation patients.…”

Section: Consequences Of Ckd After Solid-organ Transplantationmentioning

confidence: 99%

Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation

Bloom

Reese

2007

Journal of the American Society of Nephrology

164

138

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Section: Consequences Of Ckd After Solid-organ Transplantationmentioning

confidence: 99%

Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation

Bloom

Reese

2007

Journal of the American Society of Nephrology

164

138

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“…4 Long-term survival of patients with end-stage renal disease requiring hemodialysis therapy is low, with a reported survival rate of only 27% at 6 years. 7 In addition, liver transplant recipients undergoing renal retransplantation have a lower survival compared with patients undergoing primary renal transplantation. 7 Sirolimus, a newer immunosuppressive drug, has been used in solid-organ recipients.…”

mentioning

confidence: 99%

“…7 In addition, liver transplant recipients undergoing renal retransplantation have a lower survival compared with patients undergoing primary renal transplantation. 7 Sirolimus, a newer immunosuppressive drug, has been used in solid-organ recipients. 8 Less nephrotoxic than calcineurin inhibitors (CIs), [9][10][11] sirolimus is a potential alternative agent in patients who develop renal insufficiency caused by CIs.…”

mentioning

confidence: 99%

Sirolimus monotherapy in nephrotoxicity due to calcineurin inhibitors in liver transplant recipients

Nair

Eason

Loss

2003

Liver Transplantation

101

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Sirolimus, being nonnephrotoxic, is a viable alternative in patients who develop renal insufficiency caused by calcineurin inhibitors (CIs). The aim of this study is to determine whether there is improvement in renal function in liver transplant recipients after switching to sirolimusbased immunosuppression. In this retrospective review, patients who were more than 3 years posttransplantation were selected. Patients who had proteinuria (protein > 300 mg/24 hr), those administered any other nephrotoxic agents, and those with a creatinine clearance (CCr) less than 20 mL/min were excluded. Renal insufficiency was defined as mild (CCr > 70 mL/min), moderate (CCr, 40 to 70 mL/min), or severe (CCr, 20 to 40 mL/min). In the 16 patients studied; there was significant improvement in serum blood urea nitrogen (36 mg/dL; range, 19 to 53 mg/dL; to 25 mg/dL; range, 10 to 37 mg/dL; P ‫؍‬ .002) and serum creatinine levels (median, 1.95 mg/dL; range, 1.3 to 2.8 mg/dL; to 1.5 mg/dL; range, 1.0 to 2.4 mg/dL; P ‫؍‬ .001) 6 months after switching to sirolimus therapy. There also was a trend in improvement in CCr from 43 mL min (range, 24 to 68 mL/min) to 49 mL/min (range, 22 to 152 mL/min). Among 9 patients with moderate renal insufficiency, 2 patients improved to mild renal insufficiency, 4 patients remained unchanged, and 3 patients deteriorated to severe renal insufficiency. Among 7 patients with severe renal insufficiency, 1 patient improved to mild renal insufficiency, 4 patients improved to moderate renal insufficiency, and 2 patients remained unchanged. No patient developed cellular rejection or other graft-related complications. In liver transplant recipients with chronic renal insufficiency, conversion to sirolimus-based immunosuppression allows complete withdrawal of CIs, leading to some improvement in renal function. (Liver Transpl 2003;9:126-129.)

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“…The development of CRF in transplant recipients seems to be further promoted by renal impairment prior to transplantation, peri-operative hemodynamic damage to the kidneys, nephrotoxic effects of drugs, rejection episodes, dyslipidemia, hypertension and diabetes mellitus [4][5][6]. CRF itself has a high impact on patient survival following OLT [1,7,8].…”

Section: Introductionmentioning

confidence: 98%

Serum cystatin C, serum creatinine and the MDRD as predictors for renal function defined by the inulin clearance after orthotopic liver transplantation*

et al. 2011

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Background: With improved survival post liver transplantation (LT) a highly sensitive and effective monitoring of post-transplant renal function (RF) is mandatory. The aim of this study was to evaluate the prognostic value of cystatin C on RF measured by the inulin clearance 24 months after LT.Methods: 98 patients were enrolled, serum creatinine and cystatin C were collected prior to transplantation as well as 1, 6, 9, 12 and 24 months thereafter. The inulin clearance was used as reference standard for renal function with a cut off of 100 mL/min to define renal impairment 24 months after LT. All parameters were compared with respect to the defined cutoff.Results: Univariate analysis showed a prognostic impact of antihypertensive medication prior to transplantation (p ¼ 0.0008) and serum cystatin C one month after liver transplantation (p < 0.0001) on renal failure after transplantation. Auroc analysis yielded cystatin C as a superior prognostic parameter compared to creatinine based GFR in predicting renal failure as well as serum creatinine at all time points (AUROC 0.96-0.98).Conclusions: Our results revealed a high impact of serum cystatin C as an early prognostic biomarker for monitoring renal dysfunction following liver transplantation.

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Hypertension and renal dysfunction in long-term liver transplant recipients

Cited by 52 publications

References 36 publications

Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation

Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation

Sirolimus monotherapy in nephrotoxicity due to calcineurin inhibitors in liver transplant recipients

Serum cystatin C, serum creatinine and the MDRD as predictors for renal function defined by the inulin clearance after orthotopic liver transplantation*

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