MP PRAKASH1,4, TZHUO1, J HEDLEY2, A WEBSTER1,3, L KAIRAITIS4, N ROGERS1,3
1The Westmead Institue For Medical Research, Westmead Hospital, Westmead, Australia, 2Sydney School of Public Health, Sydney, Australia, 3Centre for Transplant and Renal Research, Westmead Millennium Institute, Westmead, Australia, 4Western Sydney University, Campbelltown, Australia
Background: Acute kidney injury (AKI) is a common clinical condition and is associated with significant morbidity and mortality. Kidney transplant recipients are predisposed to AKI due to surgical complications, medication toxicity and susceptibility to infection. However, existing literature on the frequency of AKI and its impact on graft survival is limited.
Aims: The aims of this study were to assess the incidence, aetiology and outcomes of AKI in a kidney transplant population.
Methods: Renal graft recipients who were transplanted at Westmead Hospital (between 2000-2017 inclusive) and with graft survival >6 months were identified. Baseline demographic data and information regarding post-transplant AKI were collected. Episodes of AKI were defined as >25% elevation in baseline creatinine not caused by rejection or BK infection. Primary outcome was graft dysfunction by measured glomerular filtration rate (GFR).
Results: Of the initial 1411 transplant recipients matching the inclusion criteria, we identified 430 who had sufficient follow-up post-AKI (>1 year). Two hundred and forty-three recipients (57%) had at least one episode of AKI (average episode/recipient 2.7±1.9), with the first episode occurring after a mean of 19.8 ± 30 months post transplantation. The majority of AKI cases occurred in male recipients (61%), and was more common in non-Caucasian and DBD recipients, although this did not reach statistical significance. The most commonly identified cause of AKI was infection/sepsis (27%). Among those with AKI in the first year post-transplantation, 18% had an eGFR of <30 mL/min/1.73m2 at one year, compared to only 7% of those without an AKI (p=0.003).
Conclusion: AKI following kidney transplantation is associated with important clinical outcomes and deleterious changes in GFR.
Madhu Prakash is currently a fourth year undergraduate student (Bachelor of Medicine and Bachelor of Surgery) at Western Sydney University. With a keen interest in nephrology, she is undertaking a research project under the supervision of Dr Natasha Rogers in the field of clinical science and transplant outcomes.