Renal Comorbidity After Solid Organ and Stem Cell Transplantation

Clajus, Christian; Hanke, Nils; Gottlieb, Jens; Stadler, Michael; Weismüller, Tobias J.; Strassburg, Christian P.; Bröcker, Verena; Bara, Christoph; Lehner, Frank; Drube, Jens; Kielstein, Jan T.; Schwarz, Anke; Gueler, Faikah; Haller, Hermann; Schiffer, Mario

doi:10.1111/j.1600-6143.2012.04047.x

Cited by 28 publications

(29 citation statements)

References 40 publications

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“…Implicated mechanisms include hepatic and cardiopulmonary failure, hemodynamic effects of prolonged surgery and blood loss, nephrotoxic effects of CNIs, sepsis, polyomavirus associated nephropathy, and TMA. 11,12 Hepatorenal syndrome and low cardiac output before transplantation may cause renal insufficiency and render transplant recipients more susceptible to postoperative AKI. 11,25 In a single-center study of 756 heart transplant recipients, cardiopulmonary bypass time (OR, 1.29), serum albumin (OR, 0.34), and insulin-requiring diabetes (OR, 3.5) were all independent predictors of AKI requiring dialysis.…”

Section: Etiologymentioning

confidence: 99%

Acute Kidney Disease After Liver and Heart Transplantation

Rossi

Vella²

2016

Transplantation

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After transplantation of nonrenal solid organs, an acute decline in kidney function develops in the majority of patients. In addition, a significant number of nonrenal solid organ transplant recipients develop chronic kidney disease, and some develop end-stage renal disease, requiring renal replacement therapy. The incidence varies depending on the transplanted organ. Acute kidney injury after nonrenal solid organ transplantation is associated with prolonged length of stay, cost, increased risk of death, de novo chronic kidney disease, and end-stage renal disease. This overview focuses on the risk factors for posttransplant acute kidney injury after liver and heart transplantation, integrating discussion of proteinuria and chronic kidney disease with emphasis on pathogenesis, histopathology, and management including the use of mechanistic target of rapamycin inhibition and costimulatory blockade.

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Section: Etiologymentioning

confidence: 99%

Acute Kidney Disease After Liver and Heart Transplantation

Rossi

Vella²

2016

Transplantation

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“…Currently, the incidence of AKI has been reported anywhere from 20% to 73% [3]. However, some studies have reported statistics as high as 92% [4]. …”

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury in Hematopoietic Stem Cell Transplantation: A Review

Krishnappa

Gupta

Manu

et al. 2016

International Journal of Nephrology

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Hematopoietic stem cell transplantation (HSCT) is a highly effective treatment strategy for lymphoproliferative disorders and bone marrow failure states including aplastic anemia and thalassemia. However, its use has been limited by the increased treatment related complications, including acute kidney injury (AKI) with an incidence ranging from 20% to 73%. AKI after HSCT has been associated with an increased risk of mortality. The incidence of AKI reported in recipients of myeloablative allogeneic transplant is considerably higher in comparison to other subclasses mainly due to use of cyclosporine and development of graft-versus-host disease (GVHD) in allogeneic groups. Acute GVHD is by itself a major independent risk factor for the development of AKI in HSCT recipients. The other major risk factors are sepsis, nephrotoxic medications (amphotericin B, acyclovir, aminoglycosides, and cyclosporine), hepatic sinusoidal obstruction syndrome (SOS), thrombotic microangiopathy (TMA), marrow infusion toxicity, and tumor lysis syndrome. The mainstay of management of AKI in these patients is avoidance of risk factors contributing to AKI, including use of reduced intensity-conditioning regimen, close monitoring of nephrotoxic medications, and use of alternative antifungals for prophylaxis against infection. Also, early identification and effective management of sepsis, tumor lysis syndrome, marrow infusion toxicity, and hepatic SOS help in reducing the incidence of AKI in HSCT recipients.

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“…AKI following a solid organ transplantation is a major cause of morbidity and mortality [10]. Unfortunately, no effective interventions are available to prevent or treat this condition, and thus there is an urgent need for development of new agents.…”

Section: Discussionmentioning

confidence: 99%

“…Despite recent advances, outcomes from AKI have not substantially changed in the last four decades and the incidence of AKI is on the rise [3]. Solid organ transplantation procedures (e.g., liver transplantation, heart transplantation, lung transplantation, and combined solid organ transplantations such as heart-lung transplant) are a recognized cause of AKI and renal transplantation is also frequently associated with AKI [4–10]. The incidence of AKI after liver transplantation reportedly ranges from 12% to 67% depending upon the definition used [4, 11].…”

Section: Introductionmentioning

confidence: 99%

Natriuretic Peptides in the Management of Solid Organ Transplantation Associated Acute Kidney Injury: A Systematic Review and Meta-Analysis

Nigwekar

Kulkarni

Thakar

2013

International Journal of Nephrology

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Randomized controlled trials involving natriuretic peptide administration in solid organ transplantation setting have shown inconsistent effects for renal endpoints. We conducted a systematic review and meta-analysis of these trials to ascertain the role of natriuretic peptides in the management of solid organ transplantation associated acute kidney injury (AKI). MEDLINE, EMBASE, and Google scholar were searched independently by two authors for randomized trials evaluating renal effects of natriuretic peptides in solid organ transplantation settings. Two reviewers independently assessed the studies for eligibility and extracted the relevant data. The pooled estimate showed that natriuretic peptide administration is associated with a reduction in AKI requiring dialysis (odds ratio = 0.50 [0.26–0.97]), a statistically nonsignificant trend toward improvement in posttransplant creatinine clearance (weighted mean difference = 5.5 mL/min, [−1.3 to 12.2 mL/min]), and reduction in renal replacement requirement duration (weighted mean difference −44.0 hours, [−60.5 to −27.5 hours]). There were no mortality events and no adverse events related to natriuretic peptides. In conclusion, administration of natriuretic peptides in solid organ transplantation may be associated with significant improvements in renal outcomes. These observations need to be confirmed in an adequately powered, prospective multicenter study.

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Renal Comorbidity After Solid Organ and Stem Cell Transplantation

Cited by 28 publications

References 40 publications

Acute Kidney Disease After Liver and Heart Transplantation

Acute Kidney Disease After Liver and Heart Transplantation

Acute Kidney Injury in Hematopoietic Stem Cell Transplantation: A Review

Natriuretic Peptides in the Management of Solid Organ Transplantation Associated Acute Kidney Injury: A Systematic Review and Meta-Analysis

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