Background: Many patients who have not undergone appropriate kidney evaluation pre-NRSOT are found to have progressive or end-stage renal disease post-NRSOT. Recipients of NRSOT who have progressive renal failure or require dialysis have high mortality rates. Creatinine and estimated glomerular filtration rate (eGFR) are poor markers for kidney function especially in chronically ill patients. The gold-standard remains the kidney biopsy. To improve evaluations of NRSOT patients, a CKD in NRSOT' clinic was created by the Transplant Nephrologists of the University of Chicago.
Methods: The clinic was established from August 1st 2011 until July 1st 2012 with the goal of appropriately listing recipients for combined-organ transplant and preventing progression of existing CKD post-NRSOT. Eligible patients had an MDRD eGFR ≤ 60ml/min (Stage 3 or greater) or a urinalysis suggestive of proteinuria/hematuria regardless of kidney function.
Results: Fifty-one patients were referred, 8 combined-organ evaluations and 43 NRSOT recipients. The combined-organ evaluation group included 4 heart-kidney (eGFRs 20-40ml/min) and 4 liver-kidney (eGFRs 20-70ml/min) evaluations. Three (37.5%) patients underwent kidney biopsy with findings listed in Table 1. In the NRSOT recipient group, 6 (14%) underwent kidney biopsy. Biopsy findings included 2 calcineurin-inhibitor (CNI) toxicity, 2 ischemic glomerulopathy/arterionephrosclerosis, 1 collapsing FSGS/diabetic nephropathy and 1 IgA nephropathy. Two of six were listed for kidney transplant within 1 year of NRSOT.
|Patient||Creatinine (mg/dL)||eGFR (ml/min)||Pathology Findings|
|A: Liver-kidney||1.4-2.2||22-38||Adv. diabetic nephropathy and severe arteriosclerosis|
|B: Heart-kidney||2.2-3.9||16-52||Moderate arterionephrosclerosis and 40% global sclerosis|
|C: Heart-kidney||1.5-1.7||42-49||Amyloid nephropathy|
Conclusions: Renal dysfunction in patients with or anticipating NRSOT requires monitoring of kidney function over time. Creatinine/eGFR remain poor predictors of renal disease. The kidney biopsy remains the gold standard and is a useful tool. Findings are varied and often unanticipated. Early Transplant Nephrology referral with eGFR as high as 60ml/min can facilitate appropriate management and should be an essential component of all Transplant programs.
To cite this abstract in AMA style:Desai A, Chon W, Josephson M. Non-Renal Solid Organ Transplant (NRSOT): The Role of the Transplant Nephrologist before Advanced Stage Chronic Kidney Disease (CKD) [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/non-renal-solid-organ-transplant-nrsot-the-role-of-the-transplant-nephrologist-before-advanced-stage-chronic-kidney-disease-ckd/. Accessed April 20, 2021.
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