Postoperative Care of the Transplanted Patient

Schumacher, K.; Gajarski, Robert J.

doi:10.2174/157340311797484286

Cited by 16 publications

(10 citation statements)

References 108 publications

(171 reference statements)

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“…In this study, we found that in the first week posttransplant there were many fluctuations in creatinine possibly due to volume status, which is a significant issue in young children . Interestingly, AKI events in the first week after transplant were not significantly associated with CKD.…”

Section: Discussionmentioning

confidence: 60%

Patterns of kidney injury in pediatric nonkidney solid organ transplant recipients

Williams

Borges

Banh

et al. 2018

American Journal of Transplantation

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The incidence of acute kidney injury (AKI) and its impact on chronic kidney disease (CKD) following pediatric nonkidney solid organ transplantation is unknown. We aimed to determine the incidence of AKI and CKD and examine their relationship among children who received a heart, lung, liver, or multiorgan transplant at the Hospital for Sick Children between 2002 and 2011. AKI was assessed in the first year posttransplant. Among 303 children, perioperative AKI (within the first week) occurred in 67% of children, and AKI after the first week occurred in 36%, with the highest incidence among lung and multiorgan recipients. Twenty-three children (8%) developed CKD after a median follow-up of 3.4 years. Less than 5 children developed end-stage renal disease, all within 65 days posttransplant. Those with 1 AKI episode by 3 months posttransplant had significantly greater risk for developing CKD after adjusting for age, sex, and estimated glomerular filtration rate at transplant (hazard ratio: 2.77, 95% confidence interval, 1.13-6.80, P trend = .008). AKI is common in the first year posttransplant and associated with significantly greater risk of developing CKD. Close monitoring for kidney disease may allow for earlier implementation of kidney-sparing strategies to decrease risk for progression to CKD.

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Section: Discussionmentioning

confidence: 60%

Patterns of kidney injury in pediatric nonkidney solid organ transplant recipients

Williams

Borges

Banh

et al. 2018

American Journal of Transplantation

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“…36,37 Furthermore, in the first week posttransplant, there were many fluctuations in creatinine levels, possibly due to volume status, representing a significant issue in terms of sensitivity and specificity of the exam, with inaccurate estimation of renal function. 38,39 Wide and different ranges of AKI prevalence were reported in several studies, ranging from 17% and 50%, with small patients cohorts, often included in retrospective studies and using different methods to evaluate GFR. [40][41][42] Seventy-seven children, who underwent LTx, were enrolled to evaluate AKI prevalence, comparing the three standardized definitions of AKI based on serum creatinine values, Pediatric RIFLE (pRI-FLE), AKIN, and KDIGO criteria.…”

Section: Acute K Idne Y Inj Ury Af Ter Ped Iatri C Lt Xmentioning

confidence: 99%

Acute and chronic kidney disease after pediatric liver transplantation: An underestimated problem

Lacquaniti

Campo

Tocco

et al. 2020

Clinical Transplantation

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Acute and chronic kidney injuries represent critical issues after liver transplantation (LTx), but whereas renal dysfunction in adult transplant patients is well documented, little is known about its prevalence in childhood. It is a challenge to accurately evaluate renal function in patients with liver disease, due to several confounding factors. Creatinine-based equations estimating glomerular filtration rate, validated in nephropathic patients without hepatic issues, are frequently inaccurate in end-stage liver disease, underestimating the real impact of renal disease. Moreover, whereas renal issues observed within 1 year from LTx were often related to acute injuries, kidney damage observed after 5-7 years from LTx, is due to chronic, irreversible mechanisms. Most immunosuppression protocols are based on calcineurin inhibitors (CNIs) and corticosteroids, but mycophenolate mofetil or sirolimus could play significant roles, also in children. Early diagnosis and personalized treatment represent the bases of kidney disease management, in order to minimize its close relation with increased mortality. This review analyzed acute and chronic kidney damage after pediatric LTx, also discussing the impact of pre-existent renal disease. The main immunosuppressant strategies have been reviewed, highlighting their impact on kidney function. Different methods assessing renal function were reported, with the potential application of new renal biomarkers.

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“…Monitoring of central venous pressure (CVP) and targeting optimum haemodynamics to ensure renal perfusion is vital. The CVP should be maintained between 5–12 mmHg, a level that provides adequate cardiac filling pressures without causing right ventricular overload [ 63 , 64 ]. In the acute phase, early continuous RRT is important to prevent fluid overload and to maintain optimum renal support.…”

Section: Diagnosis and Management Of Transplant Recipients With Renalmentioning

confidence: 99%

“…2 ). Careful attention to minimize peri-transplant renal injury, such as the avoidance of nephrotoxic drugs while awaiting transplant and optimization of peri-operative haemodynamics to prevent low cardiac output state and multiple organ failure, is important [ 8 , 63 , 64 ].…”

Section: Prevention Intervention and Education Practice And Policymentioning

confidence: 99%

Peri-operative kidney injury and long-term chronic kidney disease following orthotopic heart transplantation in children

Hoskote

Burch

2014

Pediatr Nephrol

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Significant advances in cardiac intensive care including extracorporeal life support have enabled children with complex congenital heart disease and end-stage heart failure to be supported while awaiting transplantation. With an increasing number of survivors after heart transplantation in children, the complications from long-term immunosuppression, including renal insufficiency, are becoming more apparent. Severe renal dysfunction after heart transplant is defined by a serum creatinine level >2.5 mg/dL (221 μmol/L), and/or need for dialysis or renal transplant. The degree of renal dysfunction is variable and is progressive over time. About 3–10 % of heart transplant recipients will go on to develop severe renal dysfunction within the first 10 years post-transplantation. Multiple risk factors for chronic kidney disease post-transplant have been identified, which include pre-transplant worsening renal function, recipient demographics and morbidity, peri-transplant haemodynamics and long-term exposure to calcineurin inhibitors. Renal insufficiency increases the risk of post-transplant morbidity and mortality. Hence, screening for renal dysfunction pre-, peri- and post-transplantation is important. Early and timely detection of renal insufficiency may help minimize renal insults, and allow prompt implementation of renoprotective strategies. Close monitoring and pre-emptive management of renal dysfunction is an integral aspect of peri-transplant and subsequent post-transplant long-term care.

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Postoperative Care of the Transplanted Patient

Cited by 16 publications

References 108 publications

Patterns of kidney injury in pediatric nonkidney solid organ transplant recipients

Patterns of kidney injury in pediatric nonkidney solid organ transplant recipients

Acute and chronic kidney disease after pediatric liver transplantation: An underestimated problem

Peri-operative kidney injury and long-term chronic kidney disease following orthotopic heart transplantation in children

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