title: Posttransplantation chronic renal damage in nonrenal transplant recipients.
abstract: BACKGROUND
  The growing problem of relentless deterioration of renal function in patients who undergo transplantation of nonrenal solid organs is bound to have an increasingly important impact as it may not only worsen patient morbidity and mortality but also increase transplantation costs.
  
  
  METHODS
  We reviewed the literature in order to provide a sum of the most important data on the incidence, clinical picture, renal pathology pattern, damage mechanisms, and risk factors, along with strategies for prevention and treatment of chronic renal damage following nonrenal solid organ transplantation.
  
  
  RESULTS
  Literature data report that 10% to 80% of transplanted patients have some degree of renal dysfunction and that they share a common clinical picture characterized by relentless asymptomatic progression, frequent hypertension, mild urinary abnormalities, and pathology features of vascular, glomerular, tubular, and interstitial involvement. These changes are very similar to those reported for chronic nephrotoxicity from calcineurin inhibitors. The occurrence of end-stage renal disease (ESRD) requiring chronic dialysis has been reported in up to 20% of nonrenal transplant recipients. Although there are some organ-specific differences, a group of common risk factors has been recognized, including the use of calcineurin inhibitors as immunosuppressive agents, age, pretransplantation renal function, intraoperative/perioperative factors, concomitant use of other nephrotoxic drugs, infections, and posttransplantation acute renal failure.
  
  
  CONCLUSIONS
  Calcineurin inhibitor-induced nephrotoxicity is a growing problem and, as the age of recipients of nonrenal organs is increasing, this problem is destined to increase. It would therefore be advisable for nephrologists to share their experiences in immunomodulation with other specialties, so as to favor the cautious extension of calcineurin inhibitor-sparing protocols to the area of life-saving transplants.
authors.affiliation: Department of Nephro-Urology of the Avogadro University, Maggiore Hospital, Novara, Italy. strattanefro@hotmail.com
authors.forename: Piero
authors.initials: P
authors.lastname: Stratta
authors.forename: Caterina
authors.initials: C
authors.lastname: Canavese
authors.forename: Marco
authors.initials: M
authors.lastname: Quaglia
authors.forename: Federico
authors.initials: F
authors.lastname: Balzola
authors.forename: Marco
authors.initials: M
authors.lastname: Bobbio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Busca
authors.forename: Alessandro
authors.initials: A
authors.lastname: Franchello
authors.forename: Daniela
authors.initials: D
authors.lastname: Libertucci
authors.forename: Gianna
authors.initials: G
authors.lastname: Mazzucco
mesh_terms: D006801:Humans; D015994:Incidence; D016377:Organ Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D012307:Risk Factors