Acute tubular necrosis in kidney transplantation

##plugins.themes.academic_pro.article.sidebar##

Published Jun 1, 2012
Download
pdf
Vol. 90 No. 6 (2012): Issue Jun 2012

##plugins.themes.academic_pro.article.main##

Mondher Ounissi
Taher Gargah
Samia Barbouch
Karima Boubaker
Mejda Cherif
Mohamed Mongi Bacha
Ezzeddine Abderrahim
Fethi Ben Hamida
Rachid Lakhoua
Taieb Ben Abdallah
Adel Kheder

Abstract

Background: The acute tubular necrosis (ATN) is common after kidney transplantation. Acute tubular necrosis (ATN) is multifactorial and represents one of the main causes of the delayed graft function. Its impact on graft and patients survival is documented.
Aims: To study the prevalence of the ATN in kidney transplanted patients, the acute rejection rate and their impact on the graft and the patient survival.
Methods: We retrospectively studied the frequency of ATN, its causes and its impact on patient and graft survival in 255 kidney transplanted patients between1986-2006.
Results: Thirty-nine patients had ATN (15.29%). They are 25 men and 14 women with mean age of 30.1 ± 12.6 years (8-61) followed for an average of 98 ± 61.76 months. The majority was treated by hemodialysis (79.48%) and half of them were transplanted from kidney of deceased donor. All patients received anti lymphocyte serum and the majority anticalcineurins (69.23%).
The outcome was favorable in 26 patients (66.66%) with recovery of diuresis and normalization of renal function after 6 weeks on average. An acute rejection was diagnosed in 21 patients (53.48%). The mean creatinine at 1, 5 and 10 years was 135.3, 159.9 and 121.4 μmol / l. Eight patients had creatinine ² 130 μmol / l at 10 years. Ten patients died from infectious and cardiovascular causes. By comparing the 2 groups ATN + and ATN - we found a statistically significant correlation between ATN and cold ischemia (10 ± 10.9 vs 1.2 ± 4.7 hours, p <0.0001) and the interval between the start of dialysis and transplantation (42.18 ± 38.44 vs. 31.1 ± 25.2 months, p= 0.02). No statistical correlation was found between the ATN and gender, age of recipient and donor, warm ischemia, acute rejection, chronic rejection and graft and patient survival at 1, 5 and 10 years.
Conclusion: The ATN is more common among transplanted patients from deceased donors. It had good evolution in the majority of cases and it’s correlated to cold ischemia and duration of dialysis. Finally, it has no impact on patients and graft survival

Keywords:

Transplantation, necrosis, dialysis, ischemia, survival

##plugins.themes.academic_pro.article.details##

References

  1. Hertig A. Reprise retardée de fonction rénale. Néphrol thérap 2008 ; 5 : 184-7.
  2. Jushinskis J, Trushkov S, Bicans J et al. Risk factors for development of delayed graft function in deceased donor renal transplants. Transpl Proc 2009; 41:746-8.
  3. Perico N, Cattaneo D, Sayegh MH et al. Delayed graft function in kidney transplantation. Lancet 2004; 364:1814-27.
  4. Rosenthal T. Expanded criteria for cadaver organ donation in renal transplantation. Urol Clin North Am 1994; 21:283-92.
  5. Mourad G, garrigue V, Bismuth J et al. Suivi et complications non immunologiques de la transplantation rénale. Néphrologie 2005 ; 2 : 61-82.
  6. Descotes JL, Hubert J. Apport de l'imagerie en transplantation rénale. Prog Urol 2003; 13 :1093-1114.
  7. Chow L, Sommer FG, Huang J et al. Power Doppler imaging and resistance index measurement in the evaluation of acute renal transplant rejection. J Clin Ultrasound 2001; 29:483- 90.
  8. Han F, Xiao W, Xu Y et al. The significance of BOLD MRI in differentiation between renal transplant rejection and acute tubular necrosis. Nephrol Dial Transplant 2008; 23: 2666-72.
  9. Anderson CB, Codd JE, Newton WT et al. Acute tubular necrosis. Am J Med 1993;80:1129-36.
  10. Brophy D, Najarian Js, Kjellstrand Cm. Acute tubular necrosis after renal transplantation. Transplantation 1980;29:245-8.
  11. Shoskes DA, Halloran PF. Delayed graft function in renal transplantation: etiology, management and long term significance. J Urol 1996;155:1831-40.
  12. Merion RM, Oh HK, Port FK et al. A prospective controlled trial of cold-storage versus machine perfusion preservation in cadaveric renal transplantation. Transplantation 1990; 50:230-3.
  13. Nicholson ML, Wetatley J, Horshburgh T et al. The relative influence of delayed graft function and acute rejection on renal transplant survival. Transplant Int 1996; 9: 415-9.
  14. Thomas MC, Mathew T H, Russ G R et al. peri-operative blood pressure control, delayed graft function, and acute rejection after renal transplantation. Transplantation 2003; 75:1989-95.
  15. Cho Y, Terasaki P, Graver B et al. Fifteen year kidney graft survival. Clin Transpl 1989;1: 325-34.
  16. Benoît G, Bitker MO. Complications de la transplantation rénale. Prog Urol 1996;6:771-99.
  17. Huraib S, Al Khudeir W, Al Ghamdi G et al. Post transplant acute tubular necrosis. How long you can wait? A case report. Saudi J Kidney Dis Transplant 2002;13:50-4.
  18. Diethelm QG, Blackstone EH, Naftel et al. Important factors of allograft survival in cadaveric renal transplantation. A study of 426 patients .Ann Surg 1988;207:538.
  19. Miwa H, Van Loenen M, Vanderwerf BA. The long-term effect of delayed graft function on cadaveric transplants treated with lowdose cyclosporine. Clin transpl 1989;2:275-80.
  20. Terasaki PI, Gjertson DW, Cecka JM. Significance of the donor age effect on kidney transplants. Clin Transplant 1997; 11:366-72
  21. Lim EC, Terasaki PI. Early graft function. Clin Transplant 1991;35:401-7.
  22. Bergeron E, Aboujaoude M, Sainy Louis G et al. Nécrose tubulaire aigue chez les transplantés rénaux : facteurs associés et impact sur la survie fonctionnelle de la greffe. Ann Chir 1995;8:779-99.
  23. Lewis R, Katz S, Van Buren C, Kahan B. Mechanisms and amelioration of acute renal allograft failure in the cyclosporine era. Ran Fail 1992; 14:267-84.
  24. Suthanthiran M, Haschemyer RH, Riggio RR et al. Excellent outcome with a calcium channel blocker-supplemented immunosuppressive regimen in cadaveric renal transplantation. A potential to avoid antibody induction protocols. Transplantation 1993; 55:1008-13.
  25. Cecka JM, Cho Y W, Terasaki PI. Analysis of the UNOS Scientific renal transplant registry at three years-early events affecting transplant success. Transplantation 1992; 53:59-64.
  26. Bronzatto EJM, Quadros KR, Santos RLS et al. Delayed Graft Function in Renal Transplant Recipients: Risk Factors and impact on 1-Year Graft Function: A Single Center Analysis. Transplant Proc 2009; 41: 849-51.
  27. Pallet N, Bouvier N, Legendre C et al. Antiapoptotic properties of recombinant human erythropoietin protects against tubular cyclosporine toxicity. Pharmac Res 2001; 61: 71-5.