The impact of immunosuppression on postoperative graft function after graft-unrelated surgery: a retrospective controlled cohort study

Abstract

Background Physicians are faced with a growing number of patients after renal transplantation undergoing graft-unrelated surgery. So far, little is known about the postoperative restitution of graft function and the risk factors for a poor outcome. Methods One hundred one kidney transplant recipients undergoing graft-unrelated surgery between 2005 and 2015 were reviewed retrospectively. A risk analysis was performed and differences in creatinine, GFR and immunosuppressive treatment were evaluated. Additional, a comparison with a case-matched non-transplanted control group were performed. Results Preoperative creatinine averaged 1.88 mg / dl [0.62–5.22 mg / dl] and increased to 2.49 mg / dl [0.69–8.30 mg / dl] postoperatively. Acute kidney failure occurred in 18 patients and 14 patients had a permanent renal failure. Significant risk factors for the development of postoperative renal dysfunction were female gender, a preoperative creatinine above 2.0 mg / dl as well as a GFR below 40 ml / min and emergency surgery. Patients with tacrolimus and mycophenolate mofetil treatment showed a significant lower risk of renal dysfunction than patients with other immunosuppressants postoperatively. Contrary to that, the risk of patients with cyclosporine treatment was significantly increased. Transplanted patients showed a significantly increased rate of postoperative renal dysfunction. Conclusions The choice of immunosuppressant might have an impact on graft function and survival of kidney transplant recipients after graft-unrelated surgery. Further investigations are needed. Electronic supplementary material The online version of this article (10.1186/s12882-019-1358-2) contains supplementary material, which is available to authorized users.

Gender disparity among renal transplant recipients receiving immunosuppressive therapy

“…These results are convenient with most of the studies that concluded QOL in patients after renal transplantation showed a good level for everyday life functioning comparing with other treatment options for ESRD. [2][3][4] These findings interpreted in light of renal transplant recipients are freer in terms of diet and travel than any patient on dialysis. [30] In addition, other studies concluded that renal transplantation stays the best option in the management of patients with end-stage renal disease (ESRD) as it gives the best potential quality of life, less morbidity and mortality, and great cost savings in the long term for patients with ESRD.…”

“…[2] Renal transplantation is considered the safest and the best current management option for patients with end-stage renal disease (ESRD) because it prolongs a patient's life, decreases morbidity, and consequently improves the quality of life (QOL). [3,4] On the other hand, researchers [5][6][7][8] agreed that renal transplantation is becoming the first line of management for patients with ESRD, regardless of age, when compared to renal dialysis. Kidney transplantation increases life expectancy, as well as improves both patient's physical and social functioning (quality of life), as well as intellectual stability, energy, and the overall well-being and the upcoming outlook.…”

Risk Factors and Prognosis of New-Onset Chronic Kidney Disease Following Orthotopic Liver Transplantation: A Retrospective Case-Control Study

“…Indeed, CNI drugs such as tacrolimus and cyclosporine A are the most common nephrotoxic drugs [ 26 , 27 ]. However, the risk of kidney injury was significantly lower in patients treated with the combination of tacrolimus and mycophenolate mofetil (MMF) [ 28 ]. In addition, reducing the dose of CNI used through combination therapy may effectively reduce the incidence of AKI and CKD without increasing the risk of rejection [ 29 – 31 ].…”