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Kidney Dysfunction After Vascularized Composite Allotransplantation

BACKGROUND: Kidney dysfunction is a major complication after nonrenal solid organ transplants. Transplantation of vascularized composite allografts (VCA) has yielded successful midterm outcomes despite high rates of acute rejection and greater requirements of immunosuppression. Whether this translat...

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Autores principales: Krezdorn, Nicco, Tasigiorgos, Sotirios, Wo, Luccie, Lopdrup, Rachel, Turk, Marvee, Kiwanuka, Harriet, Ahmed, Salman, Petruzzo, Palmina, Bueno, Ericka, Pomahac, Bohdan, Riella, Leonardo V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2018
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056276/
https://www.ncbi.nlm.nih.gov/pubmed/30046652
http://dx.doi.org/10.1097/TXD.0000000000000795
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author Krezdorn, Nicco
Tasigiorgos, Sotirios
Wo, Luccie
Lopdrup, Rachel
Turk, Marvee
Kiwanuka, Harriet
Ahmed, Salman
Petruzzo, Palmina
Bueno, Ericka
Pomahac, Bohdan
Riella, Leonardo V.
author_facet Krezdorn, Nicco
Tasigiorgos, Sotirios
Wo, Luccie
Lopdrup, Rachel
Turk, Marvee
Kiwanuka, Harriet
Ahmed, Salman
Petruzzo, Palmina
Bueno, Ericka
Pomahac, Bohdan
Riella, Leonardo V.
author_sort Krezdorn, Nicco
collection PubMed
description BACKGROUND: Kidney dysfunction is a major complication after nonrenal solid organ transplants. Transplantation of vascularized composite allografts (VCA) has yielded successful midterm outcomes despite high rates of acute rejection and greater requirements of immunosuppression. Whether this translates in higher risks of kidney complications is unknown. METHODS: Ninety-nine recipients of facial or extremity transplants from the Brigham and Women’s Hospital (BWH) and the International Registry on Hand and Composite Tissue Transplantation (IR) were reviewed. We assessed immunosuppression, markers of renal function over time, as well as pretransplant and posttransplant renal risk factors. RESULTS: Data were obtained from 10 patients from BWH (age at transplant, 42.5 ± 13.8 years) and 89 patients (37.8 ± 11.5 years) from IR. A significant rise in creatinine levels (BWH, P = 0.0195; IR, P < 0.0001) and drop in estimated glomerular filtration rate (GFR) within the first year posttransplant was observed. The BWH and IR patients lost a mean of 22 mL/min GFR and 60 mL/min estimated GFR in the first year, respectively. This decrease occurred mostly in the first 6 months posttransplant (BWH). Pretransplant creatinine levels were not restored in either cohort. A mixed linear model identified multiple variables correlating with renal dysfunction, particularly tacrolimus trough levels. CONCLUSIONS: Kidney dysfunction represents a major complication posttransplantation in VCA recipients early on. Strategies to mitigate this complication, such as reducing calcineurin inhibitor trough levels or using alternative immunosuppressive agents, may improve long-term patient outcomes. Standardizing laboratory and data collection of kidney parameters and risk factors in VCA patients will be critical for better understanding of this complication.
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spelling pubmed-60562762018-07-25 Kidney Dysfunction After Vascularized Composite Allotransplantation Krezdorn, Nicco Tasigiorgos, Sotirios Wo, Luccie Lopdrup, Rachel Turk, Marvee Kiwanuka, Harriet Ahmed, Salman Petruzzo, Palmina Bueno, Ericka Pomahac, Bohdan Riella, Leonardo V. Transplant Direct Hand and Composite Tissue Allotransplantation BACKGROUND: Kidney dysfunction is a major complication after nonrenal solid organ transplants. Transplantation of vascularized composite allografts (VCA) has yielded successful midterm outcomes despite high rates of acute rejection and greater requirements of immunosuppression. Whether this translates in higher risks of kidney complications is unknown. METHODS: Ninety-nine recipients of facial or extremity transplants from the Brigham and Women’s Hospital (BWH) and the International Registry on Hand and Composite Tissue Transplantation (IR) were reviewed. We assessed immunosuppression, markers of renal function over time, as well as pretransplant and posttransplant renal risk factors. RESULTS: Data were obtained from 10 patients from BWH (age at transplant, 42.5 ± 13.8 years) and 89 patients (37.8 ± 11.5 years) from IR. A significant rise in creatinine levels (BWH, P = 0.0195; IR, P < 0.0001) and drop in estimated glomerular filtration rate (GFR) within the first year posttransplant was observed. The BWH and IR patients lost a mean of 22 mL/min GFR and 60 mL/min estimated GFR in the first year, respectively. This decrease occurred mostly in the first 6 months posttransplant (BWH). Pretransplant creatinine levels were not restored in either cohort. A mixed linear model identified multiple variables correlating with renal dysfunction, particularly tacrolimus trough levels. CONCLUSIONS: Kidney dysfunction represents a major complication posttransplantation in VCA recipients early on. Strategies to mitigate this complication, such as reducing calcineurin inhibitor trough levels or using alternative immunosuppressive agents, may improve long-term patient outcomes. Standardizing laboratory and data collection of kidney parameters and risk factors in VCA patients will be critical for better understanding of this complication. Lippincott Williams & Wilkins 2018-06-01 /pmc/articles/PMC6056276/ /pubmed/30046652 http://dx.doi.org/10.1097/TXD.0000000000000795 Text en Copyright © 2018 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Hand and Composite Tissue Allotransplantation
Krezdorn, Nicco
Tasigiorgos, Sotirios
Wo, Luccie
Lopdrup, Rachel
Turk, Marvee
Kiwanuka, Harriet
Ahmed, Salman
Petruzzo, Palmina
Bueno, Ericka
Pomahac, Bohdan
Riella, Leonardo V.
Kidney Dysfunction After Vascularized Composite Allotransplantation
title Kidney Dysfunction After Vascularized Composite Allotransplantation
title_full Kidney Dysfunction After Vascularized Composite Allotransplantation
title_fullStr Kidney Dysfunction After Vascularized Composite Allotransplantation
title_full_unstemmed Kidney Dysfunction After Vascularized Composite Allotransplantation
title_short Kidney Dysfunction After Vascularized Composite Allotransplantation
title_sort kidney dysfunction after vascularized composite allotransplantation
topic Hand and Composite Tissue Allotransplantation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056276/
https://www.ncbi.nlm.nih.gov/pubmed/30046652
http://dx.doi.org/10.1097/TXD.0000000000000795
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