Renal Function Decline After Vascularized Composite Allotransplantation

Area of Science:

• Nephrology
• Transplantation Immunology
• Immunosuppression

Background:

• Chronic kidney disease (CKD) is a significant complication in nonrenal transplant recipients, impacting morbidity and mortality.
• Vascularized composite allotransplantation (VCA) requires lifelong immunosuppression, similar to solid organ transplantation.
• The specific impact of VCA on renal function requires further investigation.

Purpose of the Study:

• To investigate the renal function in recipients of vascularized composite allotransplantation (VCA).
• To assess the incidence and progression of chronic kidney disease (CKD) in VCA recipients.
• To identify potential risk factors associated with renal function decline in VCA recipients.

Main Methods:

• A multicenter study involving 70 VCA recipients (upper extremity, face, penis transplants) with a median follow-up of 8 years.
• Collection of pretransplant and posttransplant clinical data and sera.
• Calculation of estimated glomerular filtration rate (eGFR) using the CKD Epidemiology Collaboration 2021 formula.

Main Results:

• A significant decrease in median eGFR was observed by 3 months post-transplant (78.42 mL/min) compared to pretransplant levels (105.36 mL/min).
• During follow-up, 17.1% of patients had a ≥50% eGFR decline, 10.9% progressed to CKD, and 4.7% developed end-stage kidney disease.
• No statistically significant correlation was found between tacrolimus levels and eGFR decline, despite higher levels at 3 months.

Conclusions:

• Renal function declines in most VCA recipients, though the decline is less severe than in nonrenal solid organ transplant recipients.
• While a direct correlation between tacrolimus and renal decline was not established, minimizing calcineurin inhibitor exposure is recommended.
• Strategies to avoid nephrotoxic agents are crucial for preserving long-term kidney function in VCA recipients.