Introduction 1 1 19 Table 1 Percentage of patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) based on transplant type Transplant type CKD ESRD Reference Liver 28–86% 0–8% 1 5 Cardiac 7–54% 2% 6 10 Heart–lung 34% 7–16% 11 13 Hematopoietic stem cell transplantation 18–42% 5–8% 14 19 This review focuses on the epidemiology, risk factors, and outcomes of children who develop CKD after liver, cardiac, lung, heart–lung, and stem cell transplant. Liver transplant Epidemiology 20 2 1 2 2 2 3 2 4 4 Table 2 National Kidney Foundation Kidney Disease Outcomes Quality Initiative definition of chronic kidney disease by stage Stage Description 2 1 Kidney damage with normal or ↑ GFR ≥ 90 2 Kidney damage with mild ↓ GFR 60–89 3 Moderate ↓ GFR 30–59 4 Severe ↓ GFR 15–29 5 Kidney failure <15 or dialysis eGFR Risk factors for developing CKD 21 22 3 23 24 Table 3 Liver diseases associated with preexisting renal disease Tyrosinemia Autosomal recessive polycystic kidney disease Alagille’s syndrome Primary hyperoxaluria Hepatitis B- and C-related glomerulonephritis 4 2 1 20 25 26 Table 4 Risk factors for developing chronic kidney disease by type of transplant Risk factor common to all transplant types Calcineurin inhibitor use Liver 2 Pretransplant renal dysfunction Acute renal failure Preexisting diabetes Age Female gender Hepatitis C Cardiac Pretransplant dialysis Hypertrophic cardiomyopathy African American race Previous transplant Pretransplant diabetes Extracorporeal membrane oxygenation use Heart–lung Hypertension posttransplant Elevated serum creatinine at 1 month posttransplant Hematopoietic stem cell transplant Acute graft-versus-host disease grades II–IV Older age Transplant from an unrelated donor Acute renal failure Chronic graft vs. host disease Total body irradiation Calcineurin inhibitors 27 25 28 29 30 31 32 33 33 34 Cardiac transplantation Epidemiology 7 6 7 10 7 10 9 35 36 Risk factors for development of CKD after cardiac transplant 37 37 12 35 36 38 39 13 40 Calcineurin inhibitors 41 2 42 43 2 2 2 44 45 Heart–lung and lung transplantation Epidemiology 11 11 13 12 Risk factors for CKD after heart–lung and lung transplant 11 12 13 Hematopoietic stem cell transplant Epidemiology 15 17 14 46 47 Histopathology of TMA after HSCT Microscopic examination of kidney biopsy specimens from patients with TMA-associated CKD demonstrates mesangiolysis and loss of endothelial cells with expansion of the subendothelium and occlusion of capillary loops. On electron micrographs, there is extensive widening of the space between the glomerular basement membrane and the subendothelium, with amorphous deposits that are not immune complexes. Risk factors for HUS after HSCT 14 15 48 49 15 27 50 54 55 56 17 57 59 14 48 GVHD-related CKD 60 63 2 63 64 65 66 N 67 Risk factors for GVHD-related CKD 68 2 62 60 61 69 60 17 Nephrotic syndrome (NS) after HSCT 70 70 71 71 72 76 77 Management of CKD after liver, cardiac, lung, and HSCT 18 26 78 79 83 84 85 86 87 90 91 92 93 94 78 1 Fig. 1 Bold numbers 102  95 96 19 97 101 Questions Calcineurin inhibitors Total body irradiation Acute renal failure Hypertension Nephrotic syndrome Acute glomerulonephritis Thrombotic microangiopathy GVHD-related CKD Preexisting renal disease Race Pretransplant diabetes All of the above Reducing exposure to calcineurin inhibitors ACEI and/or ARB Calcium-channel blockers Statin use Graft-versus-host disease Total body irradiation Calcineurin inhibitor use Diabetes Answers: a and c b d c c