Renal complications following lung and heart-lung transplantation

As survival improves after lung and heart-lung transplants, the long term detrimental impact of current management on renal function becomes more apparent as the number of non-renal solid organ transplant recipients on renal transplant waiting lists increases. Progressive chronic kidney disease (CKD...

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Bibliographic Details
Published in:Pediatric nephrology (Berlin, West) West), 2013-03, Vol.28 (3), p.375-386
Main Authors: Robinson, Paul D., Shroff, Rukshana C., Spencer, Helen
Format: Article
Language:English
Subjects:
Adults
Child
Children and adults
Chronic illnesses
Creatinine
Glomerular Filtration Rate
Health aspects
Heart
Heart diseases
Heart-Lung Transplantation - adverse effects
Humans
Immunosuppressive Agents - adverse effects
Incidence
Kidney - physiopathology
Kidney diseases
Kidney Function Tests
Kidney transplants
Lung Transplantation - adverse effects
Lung transplants
Lungs
Measurement techniques
Medicine
Medicine & Public Health
Morbidity
Mortality
Nephrology
Pediatrics
Predictive Value of Tests
Renal Insufficiency, Chronic - diagnosis
Renal Insufficiency, Chronic - epidemiology
Renal Insufficiency, Chronic - physiopathology
Renal Insufficiency, Chronic - therapy
Review
Risk Assessment
Risk Factors
Time Factors
Transplantation
Treatment Outcome
Urology
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Description
Summary:As survival improves after lung and heart-lung transplants, the long term detrimental impact of current management on renal function becomes more apparent as the number of non-renal solid organ transplant recipients on renal transplant waiting lists increases. Progressive chronic kidney disease (CKD) is a significant cause of morbidity and mortality in the transplant population. In this review we discuss the specific problems prior to lung or heart-lung transplant that predispose to CKD, as well as potential renal complications encountered during the peri- and post-transplant period. Significant acute and chronic nephrotoxicity is caused by calcineurin inhibitors (CNI). Mechanisms to decrease CNI exposure exist but have yet to be adopted in routine clinical care. Modifiable risk factors and the current screening and management approach taken at our institution are described. Pediatric nephrologists should be involved from an early stage. Future work will need to focus on identifying more accurate measures of renal function, given the limitations of current glomerular filtration rate estimation equations in a population where nutritional status may rapidly change post transplant. Multicentre studies of CNI minimisation strategies are required to guide future therapy that aims to minimise CKD development and progression in this vulnerable population.
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-012-2200-2