Renal Failure and Mortality Trends Post Organ Transplantation

Abstract
Renal Failure (RF) is one of the most prevalent complication which can arises from various
avenues such as heart disease, heart attack, liver failure, dehydration, sepsis, kidney
complications and organ transplants from non renal solid organ transplant due to solid organ
transplant and leads to increased rate of mortality and morbidity. The risks involved entail
influence by many factors which can have direct or indirect impact on pre and post treatment
phases. Risk factors have been shown to contribute to this such as, renal function,
demographics, comorbidity, kidney injury, pre-diagnosis renal function, calcineurin inhibitor
(CNI) and nephrotoxicity. Pharmacokinetic interactions have also been shown to suppressing
the immunity and associated to renal failure medication. This literature review assess these
factors in depth and discusses them establishing literature studies on causes of high mortality
on post organ transplant in renal failure stage.
Abbreviations
RF :Renal Failure
CNI : Calcineurin inhibitor
ICU : Intensive Care Unit
CKD : Chronic Kidney Disease
GFR : Glomerular filtrate rate
HCV : Hepatitis C virus
GI : Gatro intestinal

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Literature Review
1. Introduction
Intensive Care Unit (ICU) usually associated with the care of patient in critical condition
requiring highly specialised care and organ transplant recipients immediately post-surgery are
cared in ICU. Tailored care is essential for these type of patients so that complications such
as RF are minimised and successful recovery.
Chronic Kidney Disease (CKD) often is a common complication which can develop after
organ transplantation. Complications and mortality is increased significantly among patients
diagnosed with CKD and dialysis after post-renal failure. Studies undertaken have shown that
patients having kidney diseases ranging from stage 4 and 5 have a high mortality incidence,
(Cox, 2018). The risk associated with CKD risks include pre, peri and post-re-absorptions
setting and lead to renal failure resulting in increased morbidity and mortality. Various
factors have been shown to have an effect and contribute to the development of CKD such as
recipient demographics, kidneys injury during the preoperative period and long-term
calcineurin inhibitor exposure, (Vincenti et al., 2016).
Advances in immunosuppressant, management of preoperative phase, assessment of
cardiovascular factors and infectious states have been shown to largely account for decreased
rates of mortality incidences among the organ recipients. During the transplanting phase,
renal functionality normally declines with maintaining a slower rate later, (Chawla, Eggers,
Star & Kimmel, 2014).
1.1 Aim
This literature review aims at exploring studies which have been undertaken and published
regarding development of renal failure and mortality trends post organ transplantation.
Specific investigative goals included finding out causes of RF related to different type of
solid organ transplant, complication and recommended care.
2. Methodology
Conducting an analysis in literature studies is crucial aspect of gathering evidences and
resources needed to build a case. Literature review was undertaken using databases such as
Pubmed, CINAHL and Medline using University of Tasmania online library. The key words
used in the searches undertaken included ‘renal failure’, ‘renal organ transplants’, and ‘Renal

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Literature Review
diseases’. The search strategy used two key themes focusing on the study terms with Boolean
operator, ‘and’. Observational and randomised controlled studies and those relating to
chronic kidney diseases were included. Reviews, editorials and root cause analysis studies
were excluded from the search.
3. Result
Studies searched were reviewed for their content and screened. Duplicate articles were
removed and those addressing CKD were retained. These process yielded 29 relevant articles,
on the second process, 14 articles were further selected after meeting the priori of exclusion
and inclusion criteria.
4. Discussion
4.1 Prevalence of renal failure
Globally more than the 300,000 individuals have received the liver, lungs, intestinal and liver
transplants. An estimate of 20%-25% has often experienced a preoperative acute renal failure
while 10%-15% require renal replacement therapy. Renal failure has been attributed to
increased mortality and premature morbidity of diseases among these patients, (Go, Chertow,
Fan and McCulloch, 2004).
Prevalence rates of nonrenal patients have always ranged between 10-90% as per renal failure
diagnosis criteria. Further, these shortcomings have often emanated from non accurate
assessments which depend on the serum creatinine. Patients who have undergone transplants
have low muscle mass and less creatinine compared to the general populations. Shortcomings
have been observed from larger cohorts using the Iothalamate Glomerular Filtrate Rate
(GFR) measurements which perform 1447 liver transplant on liver candidates and those
which are undertaken through transplantation, (Sandsmark et al., 2015).
Diet modification, serum creatinine and glomerular filtrates have been assessed in renal
failure. Serum and diet modification analysis showed transplantation rates of 1.15mg/dl for
serum creative and mean for ithiolamante GFR being 90.7 ml/min. The usage of the
formulas, the Modification of diet in Renal disease tool is an effective compromise to assess
this, unfortunately other studies have shown that it lacks precisions and offers an
underestimation of renal function among post-transplant patients, (Gordon, Ladner, Caicedo

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Literature Review
& Franklin, 2010).
Mortality associated measure has been undertaken on patients diagnosed with renal failure
undergoing dialysis. This has shown that the patients have GFR of estimated glomerular
filtrate rate between15-29 and <15 ml/min/1.73m2, thus having quantifying relative mortality
of renal. An assessment study in the US on kidney failure patients at stage 4-5, approach
dialysis mortality ratios with threefold and six-fold higher mortality risks higher than
Egfr>60, compared with Swedish incident patients having a CKD stage 4-5 followed for 7
years and high ratio ranging from 3.7 to 7.4 for stage 4 patients, (Schwab , Marwitz &
Woitas, 2018) .
Dialysis mortality trends in a European study showed an eightfold age-standardized mortality
rate linked to cardiovascular and noncardiovascular disease compared to the general
population.
4.2 Factors associated with renal failure end stage mortality
4.2.1 Renal function before transplantation
The function of kidney before organ transplant is a critical risks factor which is associated
with post-transplant complication. Relying on serum creatinine often leads to overestimation
of renal function among patients before transplanting especially those with poor nutritional
status, weight loss, oedema, and low muscle mass. Kidney function among patients waiting
for renal assessment is often compromised by poor effective and circulating volume which is
not reversed with successful placement to function, (Nair, Verma & Thuluvant, 2002). This
illustration is showed in figure 1 below;
Figure 1Reltionhsip between kidney injury and chronic disease both in
transplant and no transplant