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©The Author(s) 2022.
World J Transplant. Aug 18, 2022; 12(8): 231-249
Published online Aug 18, 2022. doi: 10.5500/wjt.v12.i8.231
Published online Aug 18, 2022. doi: 10.5500/wjt.v12.i8.231
Table 1 Kidney disease after pancreas transplant alone
| Ref. | Total number of patients, n | Risk factors associated with kidney disease | Study conclusion |
| Kim et al[6] | 1135 | Pre-transplant eGFR < 60 mL/min/1.73 m2. Pre-transplant eGFR 60-89.9 mL/min/1.73 m2 | PTA recipients with pre-transplant eGFR < 60 and 60-89.9 mL/min/1.73 m2 were 7.74 (95%CI: 4.37-13.74) and 3.25 (95%CI: 1.77-5.97) times more likely to develop ESKD than patients with eGFR ≥ 90 mL/min/1.73 m2 |
| Smail et al[18] | 43 | Pre-transplant eGFR < 60mL/min/1.73m2 was associated with a ESRD incidence at 1, 3, 5 yr of 0, 28.6% and 61.9% compared to those with an eGFR > 60 mL/min/1.73 m2 1, 3, 5 yr incidence of 0.82, and 12.5% (P = 0.006); age, female sex, duration of diabetes pre-PTA (all P < 0.05) | The risk of progression to ESRD after PTA may be increased in patients with pretransplant eGFR below 60 mL/min/1.73 m2, younger patients and in women |
| Gruessner et al[19] | 513 | SCr > 1.5 mg/dL at transplant, age < 30 | 5 yr post-transplant ESKD rate of 13% |
| Odorico et al[20] | 27 PTA, 61 PAK | Pre-transplant eGFR < 60 mL/min/1.73 m2 | 67% PTA patients showed an increase (> 10%) in their SCr from baseline vs 34% PAK patients (P = 0.035). PTA transplant was considered mildly renoprotective; this finding was not significant (HR = 0.29, 95%CI: 0.04-2.37, P = 0.182) |
| Chatzizacharias et al[21] | 24 | Tacrolimus levels > 12 mg/dL at 6 mo post-transplant | Tacrolimus levels, but not pre-transplant proteinuria or low eGFR < 45 mL/min/1.73 m2 were associated with CKD progression |
| Marchetti et al[22] | 28 | Stable native kidney function comparing pre-transplant to post-transplant (0.95 ± 0.2 vs 0.96 ± 0.22, P > 0.05); limited follow up of 3 mo | |
| Coppelli et al[17] | 32 | 32 PTA recipients did not have significantly different creatinine pre-and post-transplant (0.95 ± 0.25 mg/dL vs 1.00 ± 0.19 mg/dL, P > 0.05); PTA lead to improvement in lipids, BP, and albuminuria | |
| Genzini et al[23] | 45; 20-group 1 CrCl ≤ 70 mL/min; 25-group 2 CrCl > 70 mL/min | CrCl < 70 mL/min | Kidney function at 1-yr: Group 1 CrCl pre- vs post-transplantation = 57.3 ± 9 vs 34.8 ± 32 mL/min, P = 0.003); (group 2 CrCl pre- vs post-transplantation = 107.1 ± 25 vs 81.0 ± 23 mL/min, P = 0.008). In group 1, 10/20 patients (50%) ended up with a CrCl < 30 mL/min, 5/20 (25%) initiated on hemodialysis, and 3/20 (15%) underwent kidney after pancreas transplantation. No patients in group 2 ended up with significantly decreased kidney function |
| Scalea et al[24] | 123 | 88% of patients had eGFR decrease with a mean decrement of 32.1 mg/min/1.73 m2. Mean eGFR pre-transplantation was 88.9 vs 55.6 post-transplantation (P < 0.0001) with mean follow-up of 3.68 yr. Donor demographics, immunosuppression, HLA mismatch were not significantly associated with progressive CKD in their analysis |
Table 2 Kidney disease after liver
| Ref. | Total number of patients, n | Risk factors associated with kidney disease | Study conclusion |
| Ojo et al[2] | 36849 | Pre-transplant GFR ≤ 29 mL/min/1.73 m2 (RR = 3.78), post-operative renal failure (RR = 2.11), pre-transplant dialysis (RR = 1.45), hepatitis C (RR = 1.22), and pre-transplant diabetes mellitus (RR = 1.39) | 8% with CKD IV/V at 1 yr; 18.1% at 5 yr. Pre-transplant GFR, particularly that of ≤ 29 mL/min/1.73 m2, post-operative renal failure, pre-transplant dialysis, hepatitis C, and pre-transplant diabetes mellitus associated with CKD |
| Cohen et al[27] | 353 | 1 yr mGFR correlated with 3 yr mGFR (r = 0.72) | At 3 and 5 yr in both the entire group (n = 353) and intensive follow-up group (n = 191), mean mGFR was > 50 mL/min/BSA at 3 (56.5 and 56.4) and 5 yr (56.6 and 53.9). Near doubling of transplant recipients with mGFR < 40 at 3 yr posttransplant (39/191, 20.4%) vs pre-transplant (10/191, 10.5%). 15 patients (4.2%) developed ESKD. Mean time to ESKD was 7.5 yr after transplant (range = 2.5-11.3 yr). The incidence of ESKD within 10 yr was 10% ± 3%, 95%CI: 3%-15% |
| Herlenius et al[28] | 152 | mGFR 3 mo post-liver transplant below 30 mL/min/1.73 m2 predicted CKD IV, V (P = 0.03) | At 5 yr, 8 (5%) of the patients were on dialysis. GFR decreased by 36% at 5 yr and 42% at 10 yr. mGFR 3 mo post-liver transplant below 30 mL/min/1.73 m2 predicted CKD IV, V (P = 0.03) |
| Wilkinson and Pham[29] | AKI risk factors: Delayed graft function, poor liver allograft function, BMI, use of cyclosporine-A and pre-transplant AKI; CKD risk factors: Acute kidney injury, need for hemodialysis, hepatorenal syndrome, calcineurin inhibitor use, diabetes mellitus, hepatitis C, and age | 17%-95% rate of AKI with a mortality rate of 25%-74% in those on RRT vs 52% not requiring RRT; 10%-20% incidence of CKD, 2%-8% rate of ESRD with a mortality rate between 25%-50% | |
| Gonwa et al[30] | 834 | Cr by 1 mg/dL above the average of the group conferred the following risk for CRF or ESRD: Cr at 4 wk (OR = 1.598, 95%CI: 1.076-2.372), Cr at 3 mo (OR = 2.254, 95%CI: 1.262-4.025), and 1 yr Cr (OR = 2.582, 95%CI: 1.633-4.083) | “severe renal dysfunction”, CRF + ESRD in 18.1% of (OLTx) recipients after 13 yr of follow up; 6 yr after the onset of ESRD, patients receiving HD without a transplant had a survival of only 27% compared with 71.4% in the kidney transplant group (P = 0.04) |
| O'Riordan et al[26] | 230 | Univariate: Age, female gender, liver transplant from CMV positive donor to CMV positive recipient, and pre-liver transplant diabetes, pre-transplant proteinuria. Multivariate: Pre-OLT total urinary protein (OR = 7.48, 95%CI: 1.04-53.97) and female gender (OR = 7.84, 95%CI: 2.04-30.08, P < 0.005) were the most predictive | 5 yr post-liver transplant, 71% had CKD; pre-OLT total urinary protein (OR = 7.48, 95%CI: 1.04-53.97) and female gender (OR = 7.84, 95%CI: 2.04-30.08, P < 0.005) were the most predictive of CKD progression. In multivariate Cox regression analysis, GFR < 30 mL/min (HR = 3.05, 95%CI: 1.21-7.70, P = 0.02) was associated with patient survival. Similarly, survival was significantly for those with GFR < 30 mL/min compared to those with GFR > 30 mL/min in Kaplan-Meier analysis (log rank P = 0.04) |
| Wyatt and Arons[31] | 358 | Mortality in 358 liver transplant recipients who sustained AKI, irrespective of whether they required RRT or not: AKI without RRT (aOR = 8.69, 95%CI: 3.25-23.19, P < 0.0001); AKI requiring RRT (aOR = 12.07, 95%CI: 3.90-37.32, P < 0.0001) | |
| Bahirwani et al[32] | 40 | Univariate: Pre-transplant diabetes (HR = 4.23, 95%CI: 1.12-15.93, P = 0.03) and African American race (HR = 3.44, 95%CI: 1.04-11.35, P = 0.04). Multivariate: No significant predictors of CKD | 53% of recipients developed CKD stage 4 at 3 yr. At a median follow up of 1.21 yr post-transplant, 12 (30%) of recipients were on RRT |
| Cabezuelo et al[33] | 184 | Early acute renal failure: Pretransplant acute renal failure (OR = 10.2, P = 0.025), serum albumin (OR = 0.3, P = 0.001), duration of dopamine treatment (OR = 1.6, P = 0.001), and grade II-IV dysfunction of the liver graft (OR = 5.6, P = 0.002). Late postoperative risk factors: Re-operation (OR = 3.1, P = 0.013) and bacterial infection (OR = 2.9, P = 0.017) | 12% of the cohort required RRT |
| Pham et al[34] | The percentage of renal function recovery for those who were on dialysis for ≤ 30 d, 31-60 d, and 61-90 d were 71%, 56%, and 24% | ||
| Al Riyami et al[35] | 4186 | Despite a low incidence of ESRD (2.9%) in their cohort, the unadjusted mortality rate for those with AKI requiring dialysis compared to those who did not was 49.2% vs 26.8%, respectively (P < 0.001) | |
| Kollman et al[36] | 681; 57 DCD, 446 DBD; 178 LDLT | Perioperative AKI (defined as AKI within the first 7 postoperative days) was observed more often in the DCD group (61%; DBD, 40%; and LDLT, 44%; P = 0.01) | Perioperative AKI associated with DCDLT. No significant differences in stage 3 AKI per RIFLE, AKI recovery, and progression to CKD. Patient survival was significantly lower in OLTx recipients who received DCD or DBD organs and required perioperative RRT in multivariate analysis (HR = 7.90; 95%CI: 4.51-13.83; P < 0.001) |
Table 3 Kidney disease after heart
| Ref. | Total number of patients, n | Risk factors associated with kidney disease | Study conclusion |
| Ojo et al[2] | 24024 | Systemic atherosclerosis, renal hypoperfusion from cardiorenal disease | Perioperative acute renal failure rate of 20%-30% of heart transplant recipients with a 10.9% CKD IV/V rate at 60 mo post-transplant |
| Cantarovich et al[39] | 233 | 30% in CrCl between 1 mo and 3 mo independently predicted the need for chronic dialysis (P = 0.04) and time to first CrCl < 30 mL/min at > 1 yr after transplant (P = 0.01) | Early renal dysfunction predicts poor long term kidney outcomes |
| Rubel et al[40] | 370 | Multivariate analysis: GFR < 50 mL/min (HR = 3.69, P = 0.024); high mean cyclosporine trough in the first 6 mo (HR = 5.10, P = 0.0059); and presence of diabetes (HR = 3.53, P = 0.021) | Mean eGFR fell 24% at year one, 23% of patients developed a 50% reduction in GFR by year 3, and that 20% of the cohort developed ESRD at 10 yr post-transplant |
| Lindelöw et al[37] | 151 | Age | The average preoperative GFR of 66 ± 17 mL/min per 1.73 m2 declined to 52 ± 19 (P < 0.0001) at 1 yr. From 2 yr to 9 yr after heart transplantation, overall kidney function remained fairly stable (all P > 0.05) |
| Boyle et al[14] | 756 | Insulin dependent diabetes (P = 0.019) and prior cardiac surgery (P = 0.014) | AKI rate of 5.8% (44 of 756); they observed a 50% (22/44) mortality rate in OHTs with AKI requiring dialysis compared to those who did not have AKI (1.4%, 10/712) |
| Hamour et al[8] | 352 | Post-operative RRT for AKI, P < 0.001; pretransplant diabetes (P = 0.005); increasing recipient age, (P < 0.001); female recipient, (P = 0.029) and female donor (P = 0.04) associated for progression to eGFR < 45. CSA not associated | Cumulative probability of eGFR < 45 mL/min/1.73 m2 over time was the following: 45% at year 1, 71% at year 5 and 83% at year 10 |
| Wyatt and Arons[31] | 141 | Postoperative AKI, especially that requiring RRT, was associated with increased mortality (aOR = 8.96, 95%CI: 1.75-45.80, P = 0.008) |
Table 4 Kidney disease after lung
| Ref. | Total number of patients, n | Risk factors associated with kidney disease | Study conclusion |
| Ojo et al[2] | 7644 | 2.9% incidence of CKD IV/V at 12 mo and 15.8% incidence of GFR < 30 mL/min/1.73 m2 at 5 yr post lung transplant | |
| Rocha et al[41] | 296 | AKI: Baseline GFR (OR = 0.98, 95%CI: 0.96-0.99, P = 0.012), pulmonary diagnosis other than COPD (OR = 6.80, 95%CI: 1.5-30.89, P = 0.013), mechanical ventilation > 1 d (OR = 6.16, 95%CI: 1.70-22.24, P = 0.006) and parenteral amphotericin B use (OR = 3.04, 95%CI: 1.03-8.98, P = 0.045) | AKI rate of 56% (n = 166). Patient survival by AKI and AKI requiring RRT with one-year survival no AKI = 92.3%, AKI w/o RRT = 81.8% and AKI w/RRT 21.7% (P < 0.0001). At 5 (61%, 58% and 13%) and 10 yr (59%, 55% and 13%). Single lung transplant (HR = 1.78, 95%CI: 1.24-2.55, P = 0.0018) and AKI requiring RRT (HR = 6.77, 95%CI: 4.00-11.44, P < 0.0001) associated with mortality |
| Broekroelofs et al[42] | 57 | Highest median GFR in the CF recipients (-10 mL/min/year, range -14 to -6 mL/min/year), compared to those w/emphysema (-6 mL/min/year, range -27 to +12 mL/min/year) and pHTN (-1 mL/min/year, range -6 to +7 mL/min/year) | Nearly 50% decrease in mGFR at 36 mo post transplantation (100 mL/min pre-transplant vs 51 mL/min at 36 mo post-transplant) |
| Mason et al[44] | 425 | Lower creatinine clearance (P = 0.03) and greater recipient height (P = 0.0002) | HD prevalence = 0.6%, 4%, 9%, 13%, 16% and 19%, at 30 d and 1, 3, 5, 7 and 9 yr post-transplant. Mortality risk after ESRD was 100%, 17% and 3.1% per year at 3 mo, 1 yr and 3 yr, respectively. In other words, median survival after starting dialysis was 5 mo |
| Canales et al[45] | 186 | Older age, lower 1 mo GFR and CSA use in the first 6 mo were associated with faster doubling of serum creatinine (all P < 0.05) | At 1 and 7 yr, the prevalence of CKD IV (81 and 95 times) and V (10 and 20 times) were substantially higher in the lung, heart-lung transplant recipients than the general population as described by NHANES III; AKI episodes (RR = 1.6, 95%CI: 1.2-2.0, P < 0.001), and older age at transplant (RR = 1.02, 95%CI: 1.008-1.04), P = 0.004) were significant predictors of death |
| Ishani et al[9] | 186 | DBP than 90 mmHg (RR = 1.30, 95%CI: 1.05-1.60, P = 0.02), 1 mo post-transplant Cr (RR = 1.28, 95%CI: 1.02-1.70, P =0.03) were associated with increased risk to time to doubling baseline SCr | Cause of lung failure, age at transplant, nor rejection were significantly associated with doubling of Cr. Tacrolimus use in the first 6 mo after transplant was associated with a decreased in the risk for doubling time of SCr (RR = 0.38, 95%CI: 0.19-0.79, P = 0.0009) |
| Paradela de la Morena et al[46] | 161 | Older age (OR = 2.0; P < 0.001) and CMV infection (OR = 2.2; P = 0.045) | 68.6% of the cohort developed CKD; CKD at 1 yr was associated with increased mortality compared to those without CKD (P = 0.001) |
Table 5 Kidney disease after intestinal
| Ref. | Total number of patients, n | Risk factors associated with kidney disease | Study conclusion |
| Huard et al[48] | 843 | Female sex (HR = 1.34), older age (HR = 1.38/10 yr increment), catheter-related sepsis (HR = 1.58), steroid maintenance immunosuppression (HR = 1.50), graft failure (HR = 1.76), ACR (HR = 1.64), prolonged requirement for IV fluids (HR = 2.12) or TPN (HR = 1.94), and diabetes (HR = 1.54) | Cumulative incidence of severe CKD of 3.2%, 25.1%, and 54.1% 1, 5 and 10 yr after intestinal transplant; in adjusted analysis, severe CKD was associated with a significantly higher hazard of death (HR = 6.20) |
| Herlenius et al[76] | 10 | In the adult patients, GFR 3 mo post transplantation had decreased to 50% of the baseline. At 1 yr, median GFR in the adult patients was reduced by 72% (n = 5). Two patients developed renal failure within the first year and required hemodialysis | |
| Ueno et al[49] | 24 | Cumulative tacrolimus levels > 4500ng ng∙day/mL associated with significantly decreased creatinine clearance at 2 yr (P = 0.006) | Post-transplant mean creatinine clearance was significantly lower at 2 yr compared to baseline (49.6 mL/min/1.73 m2vs 114 mL/min/1.73 m2, P < 0.0001) |
- Citation: Swanson KJ. Kidney disease in non-kidney solid organ transplantation. World J Transplant 2022; 12(8): 231-249
- URL: https://www.wjgnet.com/2220-3230/full/v12/i8/231.htm
- DOI: https://dx.doi.org/10.5500/wjt.v12.i8.231