Renal failure and transplantation following nonrenal solid-organ transplantation

To review the challenges and complications related to the native kidney following nonrenal solid-organ transplantation (NRSOT).

Deterioration of renal function has been reported as an independent predictor of mortality following NRSOT. The incidence of pediatric end-stage renal disease (ESRD) after nonrenal transplantation is at least 3%, according to the 2011 United States Renal Data System Annual Report. Although calcineurin toxicity is a leading cause of renal insufficiency, other pathologic changes can be seen.

Calcineurin inhibitor nephrotoxicity in nonrenal allograft recipients can lead to ESRD and the need for kidney transplantation. There is increased morbidity and mortality associated with chronic kidney disease (CKD) following nonrenal transplantation, but few large-scale studies have been conducted in pediatric patients. Challenges exist in monitoring renal function in chronically ill pediatric patients and estimating equations using creatinine overestimate glomerular filtration rates. Collaborative research is needed to define further the incidence of CKD following NRSOT.