Presence of a Failed Kidney Transplant in Patients Who Are on Hemodialysis Is Associated with Chronic Inflammatory State and Erythropoietin Resistance

López‐Gómez, Juan M.; Pérez‐Flores, Isabel; Jofre, R.; Carretero, Diana; Rodríguez-Benítez, Patrocinio; Villaverde, Maite; Pérez‐García, Rafael; Nassar, George M.; Niembro, E; Ayus, Juan Carlos

doi:10.1097/01.asn.0000137879.97445.6e

Cited by 223 publications

(174 citation statements)

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“…It has also been shown that in patients who return to hemodialysis after graft failure and who undergo nephrectomy have a lower high-sensitivity C-reactive protein level and lower requirements for rh-EPO with higher hemoglobin levels than in patients who have returned to hemodialysis but did not undergo nephrectomy (30). This "EPO resistance" mirrors that seen in other hemodialysis patients with elevated C-reactive protein levels (31).…”

Section: Causes and Correlatessupporting

confidence: 60%

Pottransplantation Anemia

Winkelmayer

Chandraker²

2008

Clinical Journal of the American Society of Nephrology

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In recent years, there has been an increasing interest in studying the anemia that occurs after kidney transplantation. Although many of the guidelines for the treatment of kidney transplant patients, including those for anemia, are extrapolated from recommendations for patients with chronic kidney disease, there are important differences in the cause of and response to anemia in kidney transplant recipients. In addition to the correlation of anemia with kidney function as in native renal disease, many other factors are associated with the development of anemia after transplantation, including the use of medications and the inflammation/immune response. Given the lack of large, well-designed, prospective studies, the consequences of anemia, the response to treatment, and the cost-effectiveness of treatment in the posttransplantation setting are also poorly understood.Clin J Am Soc Nephrol 3: S49 -S55, 2008S49 -S55, . doi: 10.2215 A lthough anemia has been investigated with great interest and intensity in patients with chronic kidney disease (CKD), including the dialysis population, studies of the prevalence and clinical relevance of posttransplantation anemia (PTA) were scarce until a few years ago. One could argue that patients with a functioning kidney transplant are similar to patients with chronic native renal insufficiency (not on dialysis) and that evidence from the CKD population could be extrapolated to these kidney transplant recipients (KTR) (1). There are, however, at least three important reasons that such an extrapolation may not be legitimate: The presence of immunosuppressant agents and other transplant-related medications, the altered inflammatory milieu, and the history of prolonged maintenance dialysis therapy in most KTR. The altered inflammatory milieu is due to the systemic immune response to the presence of alloantigen, leading to a proinflammatory state that increases erythropoietin (EPO) resistance. Inadequate dialysis and activation of cytokines by dialysis membranes have also been shown to cause EPO resistance, but whether these factors have long-term consequences that carry over after transplantation are unknown. These and other factors may confound the validity of extrapolating scientific findings and clinical experience from the CKD (not on dialysis) population. Thus, it seems essential to establish evidence directly from the KTR population rather than through inference from patients with CKD. This article provides a critical review of the evidence on PTA. Course of Anemia after TransplantationTwo major developments have influenced the degree of anemia in patients with renal failure at the time of transplantation. The first is the widespread use of EPO for dialysis patients and patients with CKD. This has had the effect of reducing the degree of anemia in potential transplant recipients and decreased the likelihood of immunologic sensitization in patients as a result of the decreased need for blood transfusions before transplantation. Although decreasing the number of blood transfus...

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Section: Causes and Correlatessupporting

confidence: 60%

Pottransplantation Anemia

Winkelmayer

Chandraker²

2008

Clinical Journal of the American Society of Nephrology

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“…Renal allograft yetmezlikli hastalarda kronik inflamatuvar durum, artmış kardiyovasküler risk, süregelen immünsupres-yonun yol açtığı sorunlar (enfeksiyon, kanser) ve diyalize geç dönülmesi artmış mortalite oranı ile ilişkili olabilir (11,22,23).…”

Section: Renal Allograft Yetmezlikli Hastalarda Diyalize Dönüş Zamanıunclassified

“…Sonuçta allograft yetmezliği olup graft nefrektomi yapılmamış ve kronik inflamasyon bulguları gösteren rejeksiyon gelişmiş olan böbrek nakilli hastalarda transplant nefrektomi önerilmiştir (22). Öte yandan, renal allograft yetmezliği nedeniyle hemodiyalize dönen hastalarda halsizlik, iştahsızlık, ateş ve kilo kaybı gibi semptomlar olduğunda tüberküloz gibi infeksiyöz hastalıklar ve lenfoma gibi malign hastalıklar da ayırıcı tanıda düşünülmelidir.…”

Section: Türk Nefroloji Diyaliz Ve Transplantasyon Dergisi Turkish Neunclassified

“…Kronik inflamasyonun rejeksiyon gelişmiş olan böbrek nakilli hastalarda morbidite ve mortaliteyi artıran sebeplerden biri olduğu bilinmektedir (22). Bu nedenle kronik inflamasyonun kaynağı olarak rejeksiyon gelişmiş olan graftın çıkarılması gündemdedir; öte yandan, graft nefrektomi yapılmasının olumlu ve olumsuz etkileri vardır.…”

Section: Graft Nefrektomi Indikasyonlarıunclassified

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Patients with a Failed Renal Transplant

Akagun¹,

Sever²

2012

Turk Neph Dial Transpl

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ÖzRenal transplantasyon, son dönem böbrek yetmezliği (SDBY)'nin en iyi tedavisidir. Öte yandan, transplantasyondan sonra erken veya geç dönemde hastaların büyük bir kısmında graft kaybı ortaya çıkmakta ve hastalar diyalize dönmektedir. Bu hastalar immünsupresif tedavi sürecinden geçmiştir ve rutin diyaliz hastalarına kıyasla pek çok tıbbi komplikasyon (özellikle enfeksiyon ve kanser gelişimi) için riskli durumdadır. Ayrıca, transplantasyonun sağladığı kaliteli hayattan sonra diyalizin getirdiği kısıtlamalar psikolojik problemlere yol açabilir. Söz konusu problemlerin nasıl önlenebileceği veya ortaya çıktıkları zaman nasıl tedavi edileceği konusu tartışmalıdır. Bu hastaların tedavi sürecindeki belirsizliklerini şu başlıklar altında incelemek mümkündür. 1-Graft disfonksiyonunun hangi aşamasında hastalar diyalize geri dönmelidir? 2-Graft kaybı sonrasında en uygun replasman tedavisi hangisidir? 3-Bu hastalarda diyaliz süresinde ortaya çıkabilecek başlıca problemler hangileridir ve nasıl tedavi edilmelidir? 4-Hastaların almakta oldukları immünsupresif ilaçlar hangi protokole göre kesilmelidir? 5-Graft nefrektomi indikasyonları nelerdir? 6-Retransplantasyonun getiri ve götürüleri nelerdir? Bu derlemede söz konusu problemlerin çözümleri irdelenmiştir. AnAhTAR SÖzcükleR: Allograft yetmezliği, Diyalize dönüş, Graft nefrektomi, İmmünsupresyon, Retransplantasyon AbSTRAcTRenal transplantation is the best method of renal replacement therapy for patients with end-stage renal disease. On the other hand in the early or late period of transplantation, majority of patients suffer from allograft failure and return to the dialysis. These patients carry the risks of adverse effects of previous immunosuppressive therapy (i.e infections and cancers). Furthermore, worse quality of life and many limitations of dialysis result in psychological problems. The controversial issues in treatment of these patients can be summarized under the headings of : 1-In which stage of allograft failure these patients should return to dialysis? 2-Which is the most appropriate renal replacement therapy after the renal allograft failure? 3-What are the main problems during dialysis practice and how should these problems be managed? 4-How should the immunosupression regimen be managed? 5-What are the indications for transplant nephrectomy? 6-What are the advantages and drawbacks of retransplantation? In this review these problems were discussed. Öte yandan transplantasyonun sağlamış olduğu bu avantajlar sürekli değildir; bir süre sonra hastaların büyük çoğunluğunda allograft yetmezliği ortaya çıkar. Kadavra ve canlı donörlerden yapılan böbrek nakli sonrasında 5 yıllık graft sağkalımı sırasıyla %66 ve %67'dir. (4). United States Renal Data System (USRDS) veri tabanı kayıtla- GİRİŞSon dönem böbrek yetersizliği olan (SDBY) hastalarda böbrek nakli tercih edilen renal replasman tedavisidir. Diyaliz tedavisindeki hastalar ile kıyaslandığında, böb-rek nakli yapılmış olan hastaların sağkalımı (1) ve yaşam kalitesi (2) daha iyi, sağlık harcamaları ile ilgili giderle...

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“…The observation that these patients suffer from disproportionately high rates of sepsis and infection-related mortality has led to the hypothesis that a history of prolonged and ongoing exposure to chronic immunosuppression may be mediating these risks (4,8,9). Moreover, the transplanted kidney itself may be an ongoing source of systemic inflammation and hypoalbuminemia even in the absence of overt clinical evidence of rejection (10). Taken together, the role of transplant-specific modifiable practices after graft loss, including the method and rapidity of immunosuppression tapering and/or the indications for and timing of transplant nephrectomy in improving outcomes after transplant failure, remain unclear (11)(12)(13)(14).…”

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confidence: 99%

Kidney Transplant Failure

Perl

2014

Clinical Journal of the American Society of Nephrology

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Presence of a Failed Kidney Transplant in Patients Who Are on Hemodialysis Is Associated with Chronic Inflammatory State and Erythropoietin Resistance

Cited by 223 publications

References 28 publications

Pottransplantation Anemia

Pottransplantation Anemia

Patients with a Failed Renal Transplant

Kidney Transplant Failure

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