Acute Tubular Necrosis in Kidney Transplantation from Deceased Donor: Incidence and Risk Factors
Abstract
Introduction and Objectives. Acute tubular necrosis (ATN) is a frequent complication of deceased donor kidney transplantation (DDKTx) leading to delayed graft function. The objectives of this study were to evaluate the incidence and risk factors for ATN in DDKTx and the influence of ATN on graft survival at 1 and 3 years.
Material and Methods. Records of patients undergoing DDKTx in the Cluj Napoca Clinical Institute of Urology and Renal Transplantation in 2008 (61 patients of 101 in total) were analyzed. Donor, recipient and graft related factors regarding the occurrence of ATN were examined by uni and multivariate analysis.
Results. From the 101 kidney transplants performed in 2008 in our institute, 61 (60.39%) were with graft from deceased donors. ATN was diagnosed in 15 cases representing 24.59% of all DDKTx. Identified risk factors for ATN were donor age >45 years (p=0.06), non traumatic cause of donor death (p=0.03, OR 0.22), increased donor serum creatinine >1,2 mg/dl (p=0.00, OR 0.16), peritoneal dialysis as end stage renal disease treatment (p=0,001), high HLA mismatch (>/=3) (OR 4.44) and advanced iliac vascular calcifications (OR 3.75). Though high (20%), the acute rejection incidence in patients with ATN was not statistically significant as compared to those without ATN (8.51%) (p=0.34). No influence on graft and patient survival was observed at 1 and 3 years follow up but a significant longer initial hospital stay was noted in the ATN group (46.66 days compared with 15.52 days).
Conclusions. ATN as a DDKTx complication is present in 25% of cases being associated with donor age (>45 years), nontraumatic cause of donor death, altered renal function of the donor and high HLA mismatch (>/=3), and advanced iliac atheromatosis in the recipient. Short and medium term graft and patient survival were not influenced by NTA, which only affected the duration and the cost of the hospital stay.