Nagarajan Mani, Ramanathan Sakthirajan, Dhanapriya Jeyachandran, Dineshkumar Thanigachalam, Subramaniyan T Bala, Gopalakrishnan Natarajan
a Department of Nephrology , Madras Medical College & Rajiv Gandhi Government General Hospital , Chennai , Tamil Nadu , India.
Ren Fail. 2017 Nov;39(1):40-44. doi: 10.1080/0886022X.2016.1244076. Epub 2016 Oct 24.
Acute kidney injury (AKI) is one of the major determinants of graft survival in kidney transplantation (KTx). Renal Transplant recipients are more vulnerable to develop AKI than general population. AKI in the transplant recipient differs from community acquired, in terms of risk factors, etiology and outcome. Our aim was to study the incidence, risk factors, etiology, outcome and the impact of AKI on graft survival.
A retrospective analysis of 219 renal transplant recipients (both live and deceased donor) was done.
AKI was observed in 112 (51.14%) recipients, with mean age of 41.5 ± 11.2 years during follow-up of 43.2 ± 12.5 months. Etiologies of AKI were infection (47.32%), rejection (26.78%), calcineurin inhibitor (CNI) toxicity (13.39%), and recurrence of native kidney disease (NKD) (4.46%). New Onset Diabetes After Transplant (NODAT) and deceased donor transplant were the significant risk factors for AKI. During follow-up 70.53% (p = .004) of AKI recipients progressed to chronic kidney disease (CKD) in contrast to only 11.21% (p = .342) of non AKI recipients. Risk factors for CKD were AKI within first year of transplant (HR: 7.32, 95%CI: 4.37-15.32, p = .007), multiple episodes of AKI (HR: 6.92, 95%CI: 3.92-9.63, p = .008), infection (HR: 3.62, 95%CI: 2.8-5.75, p = .03) and rejection (HR: 9.92 95%CI: 5.56-12.36, p = .001).
Renal transplant recipients have high risk for AKI and it hampers long-term graft survival.
急性肾损伤（AKI）是肾移植（KTx）中移植物存活的主要决定因素之一。肾移植受者比普通人群更容易发生AKI。移植受者的AKI在危险因素、病因和预后方面与社区获得性AKI不同。我们的目的是研究AKI的发病率、危险因素、病因、预后以及AKI对移植物存活的影响。
对219例肾移植受者（包括活体和尸体供肾）进行回顾性分析。
在112例（51.14%）受者中观察到AKI，在43.2±12.5个月的随访期间，平均年龄为41.5±11.2岁。AKI的病因包括感染（47.32%）、排斥反应（26.78%）、钙调神经磷酸酶抑制剂（CNI）毒性（13.39%）和原肾疾病（NKD）复发（4.46%）。移植后新发糖尿病（NODAT）和尸体供肾移植是AKI的重要危险因素。在随访期间，70.53%（p = 0.004）的AKI受者进展为慢性肾脏病（CKD），相比之下，非AKI受者中只有11.21%（p = 0.342）进展为CKD。CKD的危险因素包括移植后第一年内发生的AKI（HR：7.32，95%CI：4.37 - 15.32，p = 0.007）、多次AKI发作（HR：6.92，95%CI：3.92 - 9.63，p = 0.008）、感染（HR：3.62，95%CI：2.8 - 5.75，p = 0.03）和排斥反应（HR：9.92，95%CI：5.56 - 12.36，p = 0.001）。
肾移植受者发生AKI的风险较高，且会妨碍移植物的长期存活。
