Ojo et al identified risk factors associated with development of chronic renal failure (CRF) in a patient after a nonrenal organ transplant. These can help identify patients who may benefit from closer monitoring and more aggressive management. The patients are from the University of Michigan in Ann Arbor.
Parameters:
(1) age of the patient
(2) gender of the patient
(3) pretransplantation infection with viral hepatitis C (HCV)
(4) blood pressure
(5) diabetes mellitus
(6) post-transplant acute renal failure (greater than 50% reduction in GFR or need for dialysis, page 937)
(7) type of organ transplant
The relative risk for age is given as 1.36 for each 10-year interval. However, the starting age was not specified. The average age for organ recipients was 45 years, except for intestine recipients (mean 19 years) and heart-lung recipients (mean 33 years). For the implementation I will add 1 point for ages 45 - 55, 2 for 55 - 65, and 3 for above.
|
Parameter |
Finding |
Points |
|
gender of the patient |
male |
0 |
|
|
female |
1 |
|
infection with HCV |
absent |
0 |
|
|
present |
1 |
|
blood pressure |
not hypertensive |
0 |
|
|
hypertensive |
1 |
|
diabetes mellitus |
absent |
0 |
|
|
present |
1 |
|
post-transplant acute renal failure |
absent |
0 |
|
|
present |
1 |
where:
• The relative risks for these parameters are low (none more than 2.13).
|
Organ Transplant |
Risk of CRF at 5 Years |
Points Assigned |
|
heart |
low to moderate (11%) |
0 |
|
heart and lung |
low (7%) |
0 |
|
lung |
moderate (16%) |
1 |
|
liver |
moderate (18%) |
1 |
|
intestine |
high (21%) |
2 |
risk score for CRF =
= SUM(points for all 7 parameters)
Interpretation:
• minimum risk score: 0
• maximum risk score based on point assignments: 10
• The greater the number of risk factors the greater the risk of developing CRF.
• Development of chronic renal failure significantly increases the risk of death (relative risk 4.6) for the patient.
Specialty: Nephrology, Clinical Laboratory, Surgery, general
