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CKD in Recipients of Nonkidney Solid Organ Transplants: A Review
1Centura Transplant, Denver, Colorado.
Abstract:
Chronic kidney disease (CKD) after solid organ transplant is a common clinical presentation, affecting 10% to 20% of liver, heart, and lung transplant recipients and accounting for approximately 5% of the kidney transplant waiting list. The causes of CKD are different for different types of transplants and are not all, or even predominantly, due to calcineurin inhibitor toxicity, with significant heterogeneity particularly in liver transplant recipients. Many solid organ transplant recipients with advanced CKD benefit from kidney transplantation but have a higher rate of death while waitlisted and higher mortality after transplant than the general kidney failure population. Recent organ allocation policies and proposals have attempted to address the appropriate identification and prioritization of candidates in need of a kidney transplant, either simultaneous with or after nonkidney transplant. Future research should focus on predictive factors for individuals identified as being at high risk for progression to kidney failure and death and on strategies to preserve kidney function and minimize the CKD burden in this unique patient population.
Insights
Chronic kidney disease (CKD) affects 10-20% of solid organ transplant recipients. Further research is needed to identify high-risk patients and develop strategies to preserve kidney function in this population.
Area of Science:
- Nephrology
- Transplant Surgery
- Immunology
Background:
- Chronic kidney disease (CKD) is a frequent complication in solid organ transplant (SOT) recipients.
- CKD affects 10-20% of liver, heart, and lung transplant recipients.
- CKD in SOT patients contributes significantly to the kidney transplant waiting list.
Purpose of the Study:
- To analyze the causes and implications of CKD in SOT recipients.
- To evaluate the benefits and risks of kidney transplantation for SOT patients with advanced CKD.
- To examine current organ allocation policies for SOT patients requiring kidney transplants.
Main Methods:
- Review of clinical data and outcomes in SOT recipients with CKD.
- Analysis of causes of CKD, noting heterogeneity across transplant types.
- Examination of mortality rates in waitlisted and post-transplant SOT patients compared to the general kidney failure population.
Main Results:
- CKD causes vary by transplant type, not solely calcineurin inhibitor toxicity.
- SOT recipients with advanced CKD have higher waitlist and post-transplant mortality.
- Kidney transplantation can benefit many SOT recipients with advanced CKD.
Conclusions:
- CKD is a significant concern in SOT recipients, with diverse etiologies.
- Current organ allocation policies aim to prioritize SOT patients needing kidney transplants.
- Future research should focus on predictive factors and kidney function preservation strategies.
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