DETROIT _ Americans who get a second chance at life with an organ transplant often go on to develop kidney failure, and may even die of it, according to the largest study on the issue.
The study, published in Thursday's New England Journal of Medicine, has important implications for the 82,581 Americans waiting for transplants.
"The message is there's an increased risk of kidney failure, that people should know about it, and they should be prepared to go through another transplant," said Dr. Akinlolu Ojo, a University of Michigan transplant specialist and senior author of the study.
Most patients are not told they face a greater likelihood of developing serious kidney problems, Ojo said.
Though the problem _ caused by the antirejection drugs recipients must take to help them retain a donor organ, along with more serious health problems in the transplant population _ is recognized in medicine, Ojo said "it is not well appreciated. We didn't know the magnitude of it."
The findings will help physicians better screen which patients are most prone to develop kidney failure after a transplant, and to possibly treat them with more moderate doses of drugs, Ojo said.
A companion editorial in the journal calls the findings "cause for concern" and recommends, as does the University of Michigan team, that patients be told up front about the issue.
"Clearly, the risk of severe chronic kidney disease must be added to the list of other risks associated with the transplantation procedure, such as opportunistic infections, cancer or bone disease," Drs. Colm Magee and Manuel Pascual wrote.
The study followed the nearly 70,000 Americans who received nonrenal transplants _ those for organs other than the kidney or pancreas _ between 1990 and 2000.
Using Medicare and Social Security records, the researchers established that 17 percent of the transplant recipients developed chronic kidney failure _ 29 percent of normal kidney function. Of those, a third went on to develop end-stage renal disease, less than 10 percent of their kidney function, and they required dialysis or a kidney transplant.
Certain transplants were associated with higher rates of kidney failure. Only 6.8 percent of heart transplant patients developed kidney failure by the third anniversary of their transplant, compared with 10 percent among lung recipients; 13.9 percent among liver recipients, and 14.2 percent of intestine recipients, the study found.
By the fifth anniversary of a transplant, nearly 11 percent of heart patients had kidney failure, compared with 15 percent for lung patients; 18 percent for liver patients, and 21.3 percent for intestine recipients.
Ojo said new drug combinations may help patients take lower doses of drugs. The University of Michigan is testing one of the medicines, sirolimus, in liver and kidney transplant patients. The drug is not appropriate for lung transplant patients, Ojo said.
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