Posttransplantation acute tubular necrosis: Risk factors and implications for graft survival

• Published in: American journal of kidney diseases Vol. 32; no. 6; pp. 984 - 991
• Main Authors: Lechevallier, E, Dussol, B, Luccioni, A, Thirion, X, Vacher-Copomat, H, Jaber, K, Brunet, P, Leonetti, F, Lavelle, O, Coulange, C, Berland, Y
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Orlando, FL Elsevier Inc 01-12-1998; Elsevier
• Subjects: Adult; Biological and medical sciences; Cadaver; Female; Graft Rejection - epidemiology; Graft Rejection - etiology; Graft Survival - physiology; Humans; Incidence; Kidney Transplantation - physiology; Kidney Transplantation - statistics & numerical data; Kidney Tubular Necrosis, Acute - epidemiology; Kidney Tubular Necrosis, Acute - etiology; Male; Medical sciences; Middle Aged; Multivariate Analysis; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prevalence; Renal Dialysis; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Time Factors; Treatment Outcome; Kidney disease; Human; Urinary system disease; Pathogenesis; Acute; Transplantation; Homotransplantation; Statistical study; Kidney; Delay; Necrosis; Renal tubule; Surgery; Risk factor; Running; Complication; Evolution
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1016/S0272-6386(98)70073-3

Previous studies aimed at identifying the causes, risk factors, and outcome of kidney transplant recipients with delayed graft function (DGF) have yielded controversial results. We retrospectively analyzed the causes and risk factors for DGF in 263 cadaveric kidney transplantations from November 1988 to March 1997 in one center. Causes of DGF were assessed by postoperative graft evolution and graft biopsy. Univariate and multivariate analysis were used to investigate the risk factors for DGF induced by acute tubular necrosis (ATN). Seventy-six patients (29%) had DGF, which was caused by ATN in 70 patients (92.1%) and acute rejection (AR) in 6 patients (7.9%). Therefore, we focused on risk factors and consequences for ATN-induced DGF. In monofactorial analysis, ATN was significantly associated with greater weight and presence of an atheromatous disease in both donor and recipient. Other risk factors for ATN were older age of donor, recipient American Society of Anesthesiology (ASA) physical status category IV, cold ischemia time (CIT), and transplantation using the right kidney. The multivariate analysis showed that donor and recipient weight, donor age, transplantation using the right kidney, preservation in Eurocollins solution, ASA score, and CIT were associated with ATN. The incidence of rejection and renal function were not different at 3 months or 1 and 5 years. ATN is the main cause of DGF in kidney transplant recipients. ATN is caused by donor and recipient vascular background, grafting the right kidney, and CIT. ATN does not appear to have an adverse effect on long-term kidney function. (Am J Kidney Dis 1998 Dec;32(6):984-91)