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Renal function and nonrenal solid organ transplantation

Author
Roy D Bloom, MD
Section Editor
Barbara Murphy, MB, BAO, BCh, FRCPI
Deputy Editor
Albert Q Lam, MD

INTRODUCTION

As outcomes following nonrenal solid organ transplantation have improved, chronic kidney disease (CKD) has become an increasingly prevalent complication in this population [1-3]. CKD occurs despite advancements in immunosuppression and perioperative management, as well as attention to cardiovascular risk factors and infectious complications [4].

The development of CKD is associated with enhanced morbidity and mortality [5].

Issues relating to kidney function following nonrenal solid organ transplantation, including the evaluation of kidney function prior to nonrenal organ transplantation, are presented in this topic review. A review of calcineurin inhibitor nephrotoxicity is presented separately. (See "Cyclosporine and tacrolimus nephrotoxicity".)

EVALUATION OF KIDNEY FUNCTION PRIOR TO NONRENAL ORGAN TRANSPLANT

As a general rule, the preoperative evaluation of kidney function in candidates for nonrenal solid organ transplantation should focus on an assessment for a past history of renal injury and dysfunction (including duration and prior reversibility), the degree of current kidney function, and the likelihood and rate of progression after solid organ transplantation. Patients who are likely to have stage 4 or stage 5 chronic kidney disease (CKD) early after nonrenal organ transplant or those with established primary renal disease that is likely to progress rapidly (thereby requiring chronic kidney replacement therapy shortly after transplant) should be listed for combined organ transplant. In an era of ever-increasing organ shortage and longer waiting times for kidneys, combined nonrenal and renal organ transplantation should be considered very judiciously. In 2016, the United Network of Organ Sharing (UNOS) approved a new policy that formalized the allocation of simultaneous liver-kidney (SLK) transplants, anticipated to go into effect in 2017 [6]. (See 'Approach in liver transplant candidates' below.)

The vast majority of patients with normal or mild impairment in kidney function should receive a nonrenal solid organ transplant alone.

                         

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Literature review current through: Nov 2016. | This topic last updated: Fri Nov 25 00:00:00 GMT 2016.
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