Role of the Nephrologist in Non-Kidney Solid Organ Transplant (NKSOT)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
- Pre-transplant period: Clinical and analytical variables present before the solid organ transplant until day 0 of the transplant.
- Peri-transplant period: From the transplant to hospital discharge.
- Post-transplant period: From hospital discharge to one year of follow-up in nephrology consultations.
2.2. Data Collection
2.3. Statistical Analysis
2.4. Data Availability
3. Results
3.1. Baseline Characteristics
3.2. Increased Baseline Creatinine by 50%
3.3. End-Stage Kidney Disease (ESKD)
3.4. Renal Replacement Therapy (RRT)
3.5. Death
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Bloom, R.D.; Reese, P.P. Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation. J. Am. Soc. Nephrol. 2007, 18, 3031–3041. [Google Scholar] [CrossRef] [Green Version]
- Miller, B.W. Chronic Kidney Disease in Solid-Organ Transplantation. Adv. Chronic Kidney Dis. 2006, 13, 29–34. [Google Scholar] [CrossRef]
- Ojo, A.O.; Held, P.J.; Port, F.K.; Wolfe, R.A.; Leichtman, A.B.; Young, E.W.; Arndorfer, J.; Christensen, L.; Merion, R.M. Chronic Renal Failure after Transplantation of a Nonrenal Organ. N. Engl. J. Med. 2003, 349, 931–940. [Google Scholar] [CrossRef]
- González-Vílchez, F.; Almenar-Bonet, L.; Crespo-Leiro, M.G.; Gómez-Bueno, M.; González-Costello, J.; Pérez-Villag, F.; Delgado-Jiménez, J.F.; del Prado, J.M.A.; Sobrino-Márquez, J.M.; Valero-Masa, M.J.; et al. Registro español de Trasplante Cardiaco. XXX Informe oficial de la Sección de Insuficiencia Cardiaca de la SEC (1984–2018). Rev. Esp. Cardiol. 2019, 72, 954–962. [Google Scholar] [CrossRef]
- Memoria de Resultados del Registro Español de Trasplante Hepático. Available online: http://www.sethepatico.org (accessed on 1 December 2022).
- Registro Español de Trasplante Pulmonar. Resultados 2001–2016. Available online: http://www.ont.es/ (accessed on 1 December 2022).
- Kim, I.-C.; Youn, J.-C.; Kobashigawa, J.A. The Past, Present and Future of Heart Transplantation. Korean Circ. J. 2018, 48, 565–590. [Google Scholar] [CrossRef] [PubMed]
- Adams, D.H.; Sanchez-Fueyo, A.; Samuel, D. From immunosuppression to tolerance. J. Hepatol. 2015, 62 (Suppl. S1), S170–S185. [Google Scholar] [CrossRef] [Green Version]
- Ivulich, S.; Westall, G.; Dooley, M.; Snell, G. The Evolution of Lung Transplant Immunosuppression. Drugs 2018, 78, 965–982. [Google Scholar] [CrossRef]
- Schwarz, A.; Haller, H.; Schmitt, R.; Schiffer, M.; Koenecke, C.; Strassburg, C.; Lehner, F.; Gottlieb, J.; Bara, C.; Becker, J.U.; et al. Biopsy-diagnosed renal disease in patients after transplantation of other organs and tissues. Am. J. Transplant. 2010, 10, 2017–2025. [Google Scholar] [CrossRef] [PubMed]
- Ortiz, A.; Sanchez-Niño, M.D.; Crespo-Barrio, M.; De-Sequera-Ortiz, P.; Fernández-Giráldez, E.; García-Maset, R.; Macía-Heras, M.; Pérez-Fontán, M.; Rodríguez-Portillo, M.; Salgueira-Lazo, M.; et al. The Spanish Society of Nephrology (SENEFRO) commentary to the Spain GBD 2016 report: Keeping chronic kidney disease out of sight of health authorities will only magnify the problem. Nefrologia 2019, 39, 29–34. [Google Scholar] [CrossRef] [PubMed]
- Wiseman, A.C. CKD in Recipients of Nonkidney Solid Organ Transplants: A Review. Am. J. Kidney Dis. 2022, 80, 108–118. [Google Scholar] [CrossRef] [PubMed]
- Campbell, P.T.; Kosirog, M.; Aghaulor, B.; Gregory, D.M.; Pine, S.; Daud, A.M.; Das, A.; Finn, D.J.M.; Levitsky, J.; Holl, J.L.M.; et al. Comanagement with nephrologist care is associated with fewer cardiovascular events among liver transplant recipients with chronic kidney disease. Transplant. Direct 2021, 7, e766. [Google Scholar] [CrossRef]
- Vondran, F.W.R.; Wintterle, S.; Bräsen, J.H.; Haller, H.; Klempnauer, J.; Richter, N.; Lehner, F.; Schiffer, M. Abdominalchirurgie trifft Nephrologie: Wichtige nephrologische Aspekte vor und nach Nieren- bzw. Lebertransplantation [Transplant Surgeon Meets Nephrologist: Important Nephrological Aspects Before and After Kidney or Liver Transplantation]. Zentralbl. Chir. 2017, 142, 180–188. [Google Scholar]
- Bloom, R.; Doyle, A. Kidney Disease After Heart and Lung Transplantation. Am. J. Transplant. 2006, 6, 671–679. [Google Scholar] [CrossRef]
- Bahirwani, R.; Campbell, M.S.; Siropaides, T.; Markmann, J.; Olthoff, K.; Shaked, A.; Bloom, R.D.; Reddy, K.R. Transplantation: Impact of pretransplant renal insufficiency. Liver Transplant. 2008, 14, 665–671. [Google Scholar] [CrossRef]
- Banga, A.; Mohanka, M.; Mullins, J.; Bollineni, S.; Kaza, V.; Torres, F.; Tanriover, B. Association of pretransplant kidney function with outcomes after lung transplantation. Clin. Transplant. 2017, 31, e12932. [Google Scholar] [CrossRef]
- Fortrie, G.; Manintveld, O.C.; Caliskan, K.; Bekkers, J.A.; Betjes, M.G. Acute Kidney Injury as a Complication of Cardiac Transplan-tation: Incidence, Risk Factors, and Impact on 1-year Mortality and Renal Function. Transplantation 2016, 100, 1740–1749. [Google Scholar] [CrossRef] [PubMed]
- Pacheco, M.P.; Carneiro-D’Albuquerque, L.A.; Mazo, D.F. Current aspects of renal dysfunction after liver transplantation. World J. Hepatol. 2022, 14, 45–61. [Google Scholar] [CrossRef] [PubMed]
- Atchade, E.; Barour, S.; Tran-Dinh, A.; Jean-Baptiste, S.; Tanaka, S.; Tashk, P.; Snauwaert, A.; Lortat-Jacob, B.; Mourin, G.; Mordant, P.; et al. Acute Kidney Injury After Lung Transplantation: Perioperative Risk Factors and Outcome. Transplant. Proc. 2020, 52, 967–976. [Google Scholar] [CrossRef] [PubMed]
- Nevens, F.; Pirenne, J. Renal disease in the allograft recipient. Best Pract. Res. Clin. Gastroenterol. 2020, 46–47, 101690. [Google Scholar] [CrossRef]
- Andreassen, A.K.; Andersson, B.; Gustafsson, F.; Eiskjær, H.; Rådegran, G.; Gude, E.; Jansson, K.; Solbu, D.; Karason, K.; Arora, S.; et al. Everolimus Initiation with Early Calcineurin Inhibitor Withdrawal in De Novo Heart Transplant Recipients: Three-Year Results from the Randomized SCHEDULE Study. Am. J. Transplant. 2016, 16, 1238–1247. [Google Scholar] [CrossRef]
- Rocha, P.N.; Rocha, A.T.; Palmer, S.M.; Davis, R.D.; Smith, S.R. Acute Renal Failure after Lung Transplantation: Incidence, Predictors and Impact on Perioperative Morbidity and Mortality. Am. J. Transplant. 2005, 5, 1469–1476. [Google Scholar] [CrossRef] [PubMed]
Global (74) | Heart (7) | Liver (34) | Lung (33) | |
---|---|---|---|---|
Age (years) | 54.39 | 49.42 | 58.71 | 51 |
Sex (%) | Males: 73 | Males: 85.7 | Males: 79.4 | Males: 63.6 |
Females: 27 | Females: 14.3 | Females: 20.6 | Females: 36.4 | |
Pre-transplantation period | ||||
Hypertension (%) | 37.8 | 57.1 | 39.4 | 33.3 |
Diabetes (%) | 27.1 | 14.3 | 51.5 | 26.1 |
Dyslipidemia (%) | 25.7 | 42.9 | 18.2 | 27.3 |
Hyperuricemia (%) | 14.9 | 14.3 | 15.2 | 15.2 |
Overweight (%) | 23 | 28.6 | 33.3 | 12.1 |
Obesity (%) | 18.9 | 28.6 | 27.3 | 9.1 |
Ex-smoker (%) | 55.4 | 42.9 | 42.4 | 72.7 |
Smoker (%) | 8.1 | 28.6 | 12.1 | 0 |
Cardiorenal syndrome (%) | 6.8 | 28.6 | 3 | 6.1 |
Hepatorenal syndrome (%) | 18.9 | 0 | 39.4 | 0 |
CKD (%) | 23 | 28.6 | 45.5 | 0 |
Stage or CKD (%) | G3a: 65.21 | G3a: 100 | G3a: 60 | G3a: 0 |
G3b: 23.91 | G3b: 0 | G3b: 26.6 | G3b: 0 | |
G4: 10.88 | G4: 0 | G4: 13.4 | G4: 0 | |
Nephrologist Follow-up (%) | 14.9 | 28.6 | 18.2 | 6.1 |
Peri-transplantation period | ||||
AKI (%) | 58.1 | 85.7 | 63.6 | 48.5 |
RRT (%) | 5.4 | 28.6 | 0 | 6.1 |
Surgical complications (%) | 51.4 | 57.1 | 30.3 | 72.7 |
Transfusion requirements (%) | 87.8 | 71.4 | 97 | 81.8 |
Vasoactive drugs (%) | 54.1 | 85.7 | 98.5 | 54.5 |
Mechanical ventilation (%) | 44.6 | 42.9 | 15.2 | 75.8 |
Infections (%) | 62.6 | 57.1 | 36.4 | 90.9 |
Tacrolimus (%) | 81.8 | 57.1 | 78.8 | 87.9 |
Cyclosporine (%) | 23 | 42.9 | 18.2 | 24.2 |
Mycophenolate (%) | 98.6 | 100 | 97 | 100 |
Everolimus (%) | 8.2 | 14.3 | 9.1 | 6.1 |
Corticosteroids (%) | 90.5 | 100 | 78.8 | 100 |
Changes in immunosuppression (%) | 14.9 | 28.6 | 12.1 | 15.2 |
Graft rejection (%) | 20.3 | 71.4 | 9.1 | 21.2 |
Calcineurin inhibitor overdose (%) | 50 | 42.9 | 21.2 | 81.8 |
Nephrotoxic substances (%) | 64.9 | 100 | 33.3 | 91 |
-NSAIDS (%) | 4.16 | 14.2 | 9 | 0 |
-Antimicrobials (%) | 31.27 | 42.9 | 63.66 | 16.7 |
-Intravenous contrast (%) | 20.80 | 42.9 | 18.31 | 16.7 |
-Combinations of nephrotoxic (%) | 43.77 | 0 | 9 | 66.6 |
Nephrologist Follow-up (%) | 18.9 | 42.9 | 21.2 | 12.1 |
Post-transplantation period | ||||
New hypertension (%) | 23 | 28.6 | 15.1 | 30.3 |
PTDM (%) | 23 | 28.6 | 15.2 | 30.3 |
New dyslipidemia (%) | 17.5 | 57.1 | 12.1 | 18.2 |
Admissions (mean) | 6.8 | 6.8 | 3.79 | 9.15 |
Infections | 78.4 | 42.9 | 69.7 | 93.9 |
Calcineurin inhibitor overdose (%) | 66.2 | 71.4 | 36.4 | 97 |
Changes in immunosuppression (%) | 68.9 | 57.1 | 51.5 | 90.9 |
Graft rejection (%) | 31.1 | 85.7 | 15.2 | 36.4 |
Nephrotoxic substances (%) | 77 | 100 | 57.6 | 93.9 |
-NSAIDS (%) | 1.75 | 0 | 5.2 | 0 |
-Antimicrobials (%) | 17.53 | 0 | 42.84 | 6.49 |
-Intravenous contrast (%) | 19.35 | 71.4 | 15.79 | 9.69 |
-Others (%) | 1.75 | 0 | 5.2 | 0 |
-Combinations of nephrotoxic (%) | 59.62 | 28.6 | 31.97 | 82.82 |
TMA (%) | 9.5 | 14.3 | 0 | 18.2 |
Final results | ||||
Time to Nephrologist follow-up (mean, months) | 33.01 | 33.71 | 28.24 | 38.64 |
Worsened renal function (%) | 45.9 | 28.57 | 44.11 | 51.5 |
Improved or stable renal function (%) | 54.1 | 74.43 | 55.89 | 48.5 |
Increased baseline creatinine by 50% (%) | 59.5 | 42.9 | 32.35 | 90.9 |
ESKD (%) | 32.43 | 14.3 | 14.7 | 54.54 |
RRT (%) | 10.8 | 14.3 | 6.1 | 15.2 |
Exitus (%) | 28.4 | 0 | 32.35 | 30.3 |
Factors | n | % | p-Value | Hazard Ratio |
---|---|---|---|---|
Type of transplant | ||||
Heart transplantation | 3 | 42.9 | p < 0.05 | HR 0.075 [95% CI] 0.01 to 0.5 |
Liver transplantation | 11 | 32.4 | p < 0.05 | HR 0.048 [95% CI] 0.012 to 0.192 |
Lung transplantation | 30 | 90.9 | p < 0.05 | ¥ |
Pre-transplant period | ||||
CKD | 3 | 17.6 | p < 0.001 | HR 0.084 [95% CI] 0.021 to 0.331 |
No follow-up by Nephrology | 41 | 65.1 | p < 0.027 | HR 4.97 [95% CI] 1.196 to 20.651 |
Peri-transplant period | ||||
Mechanical ventilation | 27 | 81.8 | p < 0.001 | HR 6.353 [95% CI] 2.155 to 18.726 |
Calcineurin inhibitor overdose | 28 | 75.7 | p < 0.006 | HR 4.083 [95% CI] 1.512 to 11.028 |
Nephrotoxic | 33 | 68.8 | p < 0.029 | HR 3 [95% CI] 1.116 to 8.064 |
Antimicrobials | 26 | 74.3 | p < 0.012 | HR 3.569 [95% CI] 1.324 to 9.62 |
Intravenous contrast | 24 | 77.4 | p < 0.009 | HR 3.943 [95% CI] 1.403 to 11.082 |
No usage of everolimus | 44 | 64.7 | p < 0.001 | HR 15722797292 |
No changes in immunosuppression | 41 | 65.1 | p < 0.027 | HR 4.97 [95% CI] 1.196 to 20.651 |
No follow-up by Nephrology | 39 | 65 | p < 0.046 | HR 3.34 [95% CI] 1.01 to 11.26 |
Post-transplant period | ||||
Calcineurin inhibitor overdose | 35 | 71.4 | p < 0.004 | HR 4.444 [95% CI] 1.594 to 12.390 |
Intravenous contrast | 31 | 70.5 | p < 0.022 | HR 3.118 [95% CI] 1.182 to 8.226 |
Nº of hospital admissions | - | - | p < 0.006 | HR 1.169 [95% CI] 1.046 to 1.306 |
Time until outpatient Nephrology consultation | - | - | p < 0.002 | HR 1.032 [95% CI] 1.011 to 1.054 |
Factors | n | % | p-Value | Hazard Ratio |
---|---|---|---|---|
Type of transplant | p < 0.001 | |||
Heart transplantation | 1 | 14.3 | p < 0.082 | HR 0.13 [95% CI] 0.015 to 1.28 |
Liver transplantation | 5 | 14.7 | p < 0.001 | HR 0.144 [95% CI] 0.045 to 0.463 |
Lung transplantation | 18 | 54.5 | This parameter is set to zero because it is redundant. | |
Peri-transplant period | ||||
Mechanical ventilation | 15 | 45.5 | p <0.035 | HR 2.963 [95% CI] 1.081 to 8.120 |
Calcineurin inhibitor overdose | 17 | 45.9 | p <0.015 | HR 3.643 [95% CI] 1.27 to 10.372 |
Antimicrobials | 16 | 45.7 | p < 0.028 | HR 3.158 [95% CI] 1.133 to 8.801 |
Intravenous contrast | 16 | 51.6 | p < 0.004 | HR 4.667 [95% CI] 1.646 to 13.232 |
Post-transplant period | ||||
Calcineurin inhibitor overdose | 20 | 40.8 | p < 0.037 | HR 3.621 [95% CI] 1.078 to 12.161 |
Antimicrobials | 18 | 42.9 | p <0.032 | HR 3.25 [95% CI] 1.106 to 9.548 |
Number of hospital admissions | p < 0.020 | HR 1.103 [95% CI] 1.015 to 1.198 |
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Viejo-Boyano, I.; López-Romero, L.C.; D’Marco, L.; Checa-Ros, A.; Peris-Fernández, M.; Garrigós-Almerich, E.; Ramos-Tomás, M.C.; Peris-Domingo, A.; Hernández-Jaras, J. Role of the Nephrologist in Non-Kidney Solid Organ Transplant (NKSOT). Healthcare 2023, 11, 1760. https://doi.org/10.3390/healthcare11121760
Viejo-Boyano I, López-Romero LC, D’Marco L, Checa-Ros A, Peris-Fernández M, Garrigós-Almerich E, Ramos-Tomás MC, Peris-Domingo A, Hernández-Jaras J. Role of the Nephrologist in Non-Kidney Solid Organ Transplant (NKSOT). Healthcare. 2023; 11(12):1760. https://doi.org/10.3390/healthcare11121760
Chicago/Turabian StyleViejo-Boyano, Iris, Luis Carlos López-Romero, Luis D’Marco, Ana Checa-Ros, María Peris-Fernández, Enrique Garrigós-Almerich, María Carmen Ramos-Tomás, Ana Peris-Domingo, and Julio Hernández-Jaras. 2023. "Role of the Nephrologist in Non-Kidney Solid Organ Transplant (NKSOT)" Healthcare 11, no. 12: 1760. https://doi.org/10.3390/healthcare11121760