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Previous Volume 349:931-940 September 4, 2003 Number 10 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Magee, C. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Transplantation of nonrenal organs is often complicated by chronic renal disease with multifactorial causes. We conducted a population-based cohort analysis to evaluate the incidence of chronic renal failure, risk factors for it, and the associated hazard of death in recipients of nonrenal transplants.

Methods Pretransplantation and post-transplantation clinical variables and data from a registry of patients with end-stage renal disease (ESRD) were linked in order to estimate the cumulative incidence of chronic renal failure (defined as a glomerular filtration rate of 29 ml per minute per 1.73 m² of body-surface area or less or the development of ESRD) and the associated risk of death among 69,321 persons who received nonrenal transplants in the United States between 1990 and 2000.

Results During a median follow-up of 36 months, chronic renal failure developed in 11,426 patients (16.5 percent). Of these patients, 3297 (28.9 percent) required maintenance dialysis or renal transplantation. The five-year risk of chronic renal failure varied according to the type of organ transplanted — from 6.9 percent among recipients of heart–lung transplants to 21.3 percent among recipients of intestine transplants. Multivariate analysis indicated that an increased risk of chronic renal failure was associated with increasing age (relative risk per 10-year increment, 1.36; P<0.001), female sex (relative risk among male patients as compared with female patients, 0.74; P<0.001), pretransplantation hepatitis C infection (relative risk, 1.15; P<0.001), hypertension (relative risk, 1.18; P<0.001), diabetes mellitus (relative risk, 1.42; P<0.001), and postoperative acute renal failure (relative risk, 2.13; P<0.001). The occurrence of chronic renal failure significantly increased the risk of death (relative risk, 4.55; P<0.001). Treatment of ESRD with kidney transplantation was associated with a five-year risk of death that was significantly lower than that associated with dialysis (relative risk, 0.56; P=0.02).

Conclusions The five-year risk of chronic renal failure after transplantation of a nonrenal organ ranges from 7 to 21 percent, depending on the type of organ transplanted. The occurrence of chronic renal failure among patients with a nonrenal transplant is associated with an increase by a factor of more than four in the risk of death.

Source Information

From the Scientific Registry of Transplant Recipients (A.O.O., P.J.H., F.K.P., R.A.W., A.B.L., E.W.Y., J.A., L.C., R.M.M.) and the Departments of Medicine (A.O.O., A.B.L., E.W.Y.), Biostatistics (R.A.W.), and Surgery (R.M.M.), University of Michigan, Ann Arbor.

Address reprint requests to Dr. Ojo at the University of Michigan Medical School, Division of Nephrology, 3914 Taubman Ctr., Box 0364, Ann Arbor, MI 48109-0364, or at aojo{at}umich.edu.

Full Text of this Article

Related Letters:

Chronic Renal Failure after Transplantation of a Nonrenal Organ
Gonwa T. A., Mai M. L., Klintmalm G. B., Parikh C. R., McSweeney P. A., Kida Y., Campo A., Ojo A. O., Leichtman A., Merion R.
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N Engl J Med 2003; 349:2563-2565, Dec 25, 2003. Correspondence

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