Acute kidney injury as defined by the RIFLE criteria is a risk factor for kidney transplant graft failure

Abstract

Acute kidney injury (AKI) is not recognized as a major complication at the maintenance phase after kidney transplantation (KTx). Moreover, it is not clear whether the onset of AKI leads to graft failure. We examined the incidence of AKI that developed three months or later after KTx at our institute. We examined whether the incidence of AKI defined by the Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function and End-stage kidney disease criteria associates with graft failure by matched-pair Cox regression analysis. A total of 289 patients were available for the final analysis. The overall incidence of AKI was 20.4%, and the common etiology of AKI was bacterial infectious diseases. The group that developed AKI had significantly lower graft survival than non-AKI group independently of acute rejection. AKI Risk represented a high risk for graft failure and AKI Injury/Failure represented a higher risk for graft failure. The analysis by the AKIN classification yielded the similar results. These results indicate that AKI is a relatively common complication of KTx and represents the major risk for graft failure. We should make every effort in the prevention and early detection to avoid the occurrence of AKI and the subsequent graft failure after KTx.

AKI in kidney transplant recipients—here to stay

“…Consistent with this idea, the incidence of AKI using RIFLE criteria was 20.4% in the cohort of kidney transplant recipients followed by Nakamura et al for a period of 46 months beginning 3 months after transplantation. 5 In summary, the present study by Mehrotra et al demonstrates the increasing incidence of AKI and its association with allograft failure and death in renal transplant recipients. The results of the study add to a growing body of literature that has dispelled the myth that AKI represents a reversible injury with minimal long-term sequelae.…”

“…For example, Nakamura et al recently reported that infectious etiologies represented the most common cause of AKI in a cohort of 289 kidney transplant recipients. 5 In particular, urinary tract infections were the most common infectious etiology, which were probably related to immunosuppression and urologic reconstructive diversions. 5 Recent studies have demonstrated that AKI is associated with CKD, an association now confirmed by Mehrotra et al in kidney transplant recipients.…”

“…5 In particular, urinary tract infections were the most common infectious etiology, which were probably related to immunosuppression and urologic reconstructive diversions. 5 Recent studies have demonstrated that AKI is associated with CKD, an association now confirmed by Mehrotra et al in kidney transplant recipients. Liaño et al reported the results of a study that followed a cohort of 177 patients with acute tubular necrosis for a median of 7.2 years.…”

Inpatient Management of Postrenal Transplant Patients

“…3,4 Incidence of AKI is around 11% to 20% in different studies. The clinical approach to AKI in renal transplant patients is similar to general hospitalized patients.…”

Neutrophil gelatinase-associated lipocalin in kidney transplantation: A review

“…Utility of NGAL assessment after AKI in late post-transplantation period (Fig. 1c) KTR have an increased risk of severe AKI which carries with it high risk of graft failure [38]. Paradoxically AKI might be more frequent in KTRs with higher eGFR [39].…”