Zafar Zoha, Manzoor Adil, Shahid Rabia
Nephrology, Pakistan Kidney and Liver Institute and Research Centre, Lahore, PAK.
Cureus. 2025 Mar 9;17(3):e80277. doi: 10.7759/cureus.80277. eCollection 2025 Mar.
Objective The study aimed to determine the incidence of acute kidney injury (AKI) in renal transplant recipients in the first month after transplant. The number of AKI episodes per patient and their outcome on renal graft function were also determined. Material and methods It is a retrospective study that took place in the Nephrology Department of Pakistan Kidney and Liver Institute and Research Center (PKLI & RC), Lahore, Pakistan. A total of 195 patients aged 18-70 years who underwent kidney transplant surgery at PKLI & RC, Lahore, were selected in this cohort that underwent renal transplants from 31st January 2024 to 31st December 2024. One month post-transplant course was followed by obtaining serum creatinine level values. Data was analyzed using Microsoft Excel (Microsoft® Corp., Redmond, WA, USA). Results A total of 81 out of 195 patients (41.5%) had AKI within the first 30 days following a renal transplant. Seventy patients experienced AKI once (86.4%), meanwhile, 11 patients (13.5%) had two episodes of AKI within the first 30 days. Staging done as per Kidney Disease Improving Global Outcomes (KDIGO) guidelines showed that 73 patients had stage I AKI (90.1%). Three patients had stage II AKI (3.7%), while five patients had stage III AKI (6.2%). The most common cause was found to be pre-renal (dehydration) in 24 patients out of 81 (29.6%) and followed by a urinary tract infection in 23 patients (28.3%). Twenty patients (24.6%) had drug-induced AKI; there was calcineurin inhibitor (CNI) toxicity in 8.6% and acute tubular necrosis (ATN) in 7.4% of patients. One patient had acute antibody-mediated rejection (ABMR). Most cases of AKI were found to be self-limiting, with complete resolution to baseline renal allograft function. Conclusion Even though most episodes of AKI completely resolved to baseline creatinine, it is pivotal to timely diagnose and treat AKI in post-renal transplant patients. If left untreated, there can be a worsening of graft function and overall outcome of the transplant.
目的 本研究旨在确定肾移植受者移植后第一个月内急性肾损伤（AKI）的发生率。同时还确定了每位患者的AKI发作次数及其对肾移植功能的影响。材料与方法 这是一项回顾性研究，在巴基斯坦拉合尔的巴基斯坦肾脏和肝脏研究所及研究中心（PKLI & RC）肾脏病科进行。本队列研究选取了2024年1月31日至2024年12月31日在拉合尔PKLI & RC接受肾移植手术的195例年龄在18 - 70岁的患者。在移植后一个月追踪血清肌酐水平值。数据使用Microsoft Excel（美国华盛顿州雷德蒙德微软公司）进行分析。结果 195例患者中共有81例（41.5%）在肾移植后的前30天内发生了AKI。70例患者经历了一次AKI（86.4%），同时，11例患者（13.5%）在最初30天内发生了两次AKI发作。按照改善全球肾脏病预后组织（KDIGO）指南进行分期显示，73例患者为I期AKI（90.1%）。3例患者为II期AKI（3.7%），5例患者为III期AKI（6.2%）。最常见的病因是肾前性（脱水），81例中有24例（29.6%），其次是尿路感染，有23例（28.3%）。20例（24.6%）为药物性AKI；8.6%的患者存在钙调神经磷酸酶抑制剂（CNI）毒性，7.4%的患者发生急性肾小管坏死（ATN）。1例患者发生急性抗体介导的排斥反应（ABMR）。大多数AKI病例被发现是自限性的，肾移植功能完全恢复至基线水平。结论 尽管大多数AKI发作完全恢复至基线肌酐水平，但及时诊断和治疗肾移植后患者的AKI至关重要。如果不进行治疗，移植功能和移植的总体预后可能会恶化。
