Patient Factors Influence Eye Lesion Incidence after Kidney Transplant

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Evidence from a recent cross-sectional study provides new insight into the incidence of ocular lesions 1 year after kidney transplantation and the post-transplant influential factors associated with cataracts and optic nerve atrophy status.¹

After kidney transplantation, the investigation suggests new-onset diabetes and daily dosage of prednisolone are factors associated with cataract status, while the primary predisposing factor for optic nerve atrophy was systemic infection post-procedure.

“Our study is the first study conducted on post-kidney transplant subjects in Vietnam,” wrote the investigative team, led by Nguyen Le Trung, department of ophthalmology, Hanoi Medical University. “The study provides evidence of the incidence of certain eye lesions and influence factors after transplantation to guide eye treatment for this population.”

Given the development of immunosuppression and surgery, kidney transplantation has become a standard treatment choice due to its improved survival rates and quality of life. There are still critical warnings, however, for those vulnerable to eye damage after a kidney transplant, despite the lack of a comprehensive assessment.²

Eye lesions have shown different rates across studies when utilizing systemic immunosuppressants but can predate transplantation and continue to progress after the procedure. Lesions can also appear after transplantation, with typical lesions including cataracts, dry eye conditions, glaucoma, and retinal damage.

To better understand the incidence of eye lesions, and evaluate the effects of post-transplant factors, investigators described ocular lesions one year after a kidney transplant and analyzed the influence of patient characteristics on eye lesions after kidney transplantation.¹ They identified a total of 111 patients (222 eyes) who had kidney transplantations between January 2021 - December 2022, 103 of whom agreed to participate in the study.

Participants were measured for best-corrected visual acuity (BCVA) using a 5m distance Snellen electronic vision panel. Investigators assessed dry eye conditions using the Ocular Surface Disease Index (OSDI) questionnaire, setting tear secretion time (Schirmer test), and tear film break-up time (BUT test). Pupil dilation using a tropicamide and phenylephrine combination was used to evaluate the posterior segment of the eye.

Criteria for diagnosing dry eyes included the Schirmer Test < 10mm, the BUT< test 10 seconds, and OSDI > 10 points. Independent study factors included age, gender, and diastolic and systolic blood pressure, as well as comorbid systemic diseases and doses and treatment patterns were collected from the electronic medical record of the post-transplant clinic.

Demographics of the study population showed men accounted for the majority of patients (76%), particularly those of high working age. After kidney transplant, hypertension rates were high (73%) and required antihypertensive drug treatment, with most patients receiving calcium channel blockers (31.5%). For most patients (76%), the immunosuppressive drug regimen consisted primarily of 3 drugs, with high dosages: tacrolimus, mycophenolate mofetil (MMF), and prednisolone.

Upon analysis, the highest prevalence of retinopathy was 84.7%, with 9.9% of eyes having atrophy of the optic nerve and 1.8% of eyes with epiretinal membranes. The analysis showed dry eye disease in 59.5%, a cataract rate of 29.7%, and corneal conjunctival calcification in 24.8% of eyes. Investigators noted the highest proportion of retinal lesions included hypertensive forms of retinal lesions (n = 188), atrophy of the optic nerve (n = 19), epiretinal membrane (n = 3), followed by dye eye lesions (n = 132), cataracts (n = 66), and corneal calcification lesions (n = 55).

Regarding the grade of corneal conjunctival calcium, Grade 1 accounted for most patients (49%), while posterior subcapsular turbidity predominated the cataract grade (71.2%). Mild retinal lesions accounted for the majority of hypertensive retinopathy (88.8%).

Investigators found the post-transplant influence factors associated with cataracts included the daily dose of prednisolone (odds ratio [OR], 1.6; 95% CI, 1.2 - 1.8; P <.05) and post-transplant diabetes (OR, 1.4; 95% CI, 1.2 - 1.6; P <.05). The team also identified a significant difference in posttransplant infection (OR, 2.4; 95% CI, 1.6 - 3.0; P <.05) affecting optic nerve atrophy.

However, in their conclusion, the team noted the study is unable to conclude the correlation of some systemic factors that affect the eye before a kidney transplant.

“The limitation of our study is the use of cross-sectional description, so it is impossible to conclude the cause-and-effect relationship of some systemic factors that affect the pre-transplant eye, such as hypertension,” they wrote.

References

1. Trung NL, Toan PQ, Trung NK, Tuan VA, Huyen NT. Eye Lesions in Patients After One Year of Kidney Transplantation. Clin Ophthalmol. 2023;17:2861-2869
2. Thomas AG, Ruck JM, Chu NM, et al. Kidney transplant outcomes in recipients with visual, hearing, physical and walking impairments: a prospective cohort study. Nephrol Dial Transplant. 2020;35(7):1262–1270. doi:10.1093/ndt/gfz164