Hafeez Abdul Rauf, Kumar Ranjeet, Jafry Nazarul Hassan, Rehman Muniba
Abdul Rauf Hafeez Associate Professor, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
Ranjeet Kumar, Assistant Professor, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
Pak J Med Sci. 2025 Mar;41(3):763-768. doi: 10.12669/pjms.41.3.10371.
We aimed to assess the renal allograft and patient survival following acute kidney injury requiring dialysis therapy.
We analyzed the medical record of 3000 first living donor kidney transplant performed between 2008 to 2017 for AKI requiring dialysis at Sindh Institute of Urology and Transplantation, Karachi, Pakistan. Patients less than 15 years of age and those AKI events that happened less than three months post renal transplant were excluded. Renal allograft and patient survival were recorded at discharge and one-year post AKI. Recovery of renal functions was assessed at three-month.
AKI requiring dialysis therapy was identified in 154 (5.1%) patients. At discharge, 115 (74.7%) were alive and 71 (61.7%) of them were dialysis free. At three-month, out of 71 dialysis free patients, 11 (15.5%) had complete recovery, 54 (76%) had partial recovery and six (8.5%) required dialysis again. At one-year, 98 (63.6%) patients were alive and 42 (42.9%) of them were dialysis free. Infectious etiology of AKI (= 0.000; 0R 6.00; CI, 2.3-15.08) and more than two non-dialysis -requiring AKI in the past ( 0.017; OR 3.04; CI, 1.2-7.5) were the risk factors of in-hospital mortality. Non-infectious cause of AKI (=0.000; OR 45.5; CI, 9.9-206) and being off calcineurin inhibitors (=0.014; OR 4.4; CI, 1.3-14.8) were the risk factors of dialysis dependency at hospital discharge.
Dialysis-requiring AKI secondary to infectious etiology has both high mortality and chances of recovery in survivors. They need prompt diagnosis and treatment. Non-infectious etiology and being off CNI are the risk factors of graft loss in dialysis-requiring AKI.
我们旨在评估需要透析治疗的急性肾损伤后肾移植受者的移植肾存活情况及患者生存率。
我们分析了2008年至2017年间在巴基斯坦卡拉奇市信德泌尿与移植研究所进行的3000例首次活体供肾移植手术的病历，这些患者因急性肾损伤需要透析治疗。排除年龄小于15岁的患者以及肾移植后不到三个月发生的急性肾损伤事件。记录出院时及急性肾损伤后一年的移植肾存活情况及患者生存率。在三个月时评估肾功能恢复情况。
154例（5.1%）患者被确定为需要透析治疗的急性肾损伤。出院时，115例（74.7%）存活，其中71例（61.7%）无需透析。在三个月时，71例无需透析的患者中，11例（15.5%）完全恢复，54例（76%）部分恢复，6例（8.5%）再次需要透析。一年时，98例（63.6%）患者存活，其中42例（42.9%）无需透析。急性肾损伤的感染病因（=0.000；比值比6.00；可信区间，2.3 - 15.08）以及过去有超过两次无需透析的急性肾损伤（=0.017；比值比3.04；可信区间，1.2 - 7.5）是院内死亡的危险因素。急性肾损伤的非感染病因（=0.000；比值比45.5；可信区间，9.9 - 206）以及停用钙调神经磷酸酶抑制剂（=0.014；比值比4.4；可信区间，1.3 - 14.8）是出院时依赖透析的危险因素。
由感染病因引起的需要透析的急性肾损伤死亡率高，但幸存者有恢复的机会。它们需要及时诊断和治疗。非感染病因以及停用钙调神经磷酸酶抑制剂是需要透析的急性肾损伤中移植肾丢失的危险因素。
