Chronic Renal Failure Significant Risk for Non-Renal Organ Transplant Recipients

New England Journal of Medicine NEJM)

By Keely S. Solomon, PhD

Chronic renal failure CRF), a serious complication of non-renal organ transplantation which leads to increased morbidity and mortality, may occur in as many as one-fifth of recipients.

Investigators, led by Akinlolu O. Ojo, M.D., of the University of Michigan, performed an analysis to determine the incidence of CRF and the associated risk factors and risk of death for non-renal transplant recipients.

The study included data for 69,321 patients (mean age, 45; males, 63%) who received heart, lung, heart-lung, liver, or intestine transplants between 1990 and 2000. Primary end point was CRF or end-stage renal disease (ESRD).

According to Dr. Ojo, CRF occurred in 16.5% of the patients during follow-up time median follow-up, 36 months), leading to end-stage renal disease for 28.9% this group. The 5-year cumulative incidence of CRF was highest for intestine transplants (21.3%) and lowest for heart-lung transplants 6.9%).

Factors associated with an increased risk for CRF included increasing age, female sex, post-operative acute renal failure, diabetes mellitus, hepatitis C, and hypertension. For patients who received liver transplants, the excess risk associated with the use of a calcineurin inhibitor was greater with cyclosporine therapy than tacrolimus.

CRF was associated with an elevated risk of death for the transplant recipients, and this increased risk was not entirely accounted for by ESRD; patients with CRF in whom ESRD had not developed had a risk of death twice as high as recipients without CRF. Among the patients with ESRD, those who received a kidney transplant had a lower risk of death during the subsequent 5 years than those on dialysis.

Based on the results of this analysis, the researchers recommend that "attention to pre-existing renal diseases, pre-transplantation renal function, and modifiable cardiovascular risk factors might reduce the long-term risk of chronic renal failure after the transplantation of non-renal organs."

N Engl J Med 2003 Sep 4;349:10:931-40.

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This article posted September 25, 2003.