Introduction:
Acute Tubular Necrosis (ATN) is a significant post-transplant complication affecting graft function and patient outcomes. It results mainly from ischemia-reperfusion injury, calcineurin inhibitor toxicity, and acute rejection. This study aimed to identify risk factors, etiologies, and long-term outcomes of ATN in renal transplant recipients.
Methods:
We conducted a retrospective cohort study at a tertiary care centre between 2019 and 2022, including 304 renal transplant recipients, 55 (18.1%) of whom developed ATN within 30 days post-transplant. The analytical protocol included etiological analysis, multivariate risk factor modelling, diagnostic test evaluation, and longitudinal outcome assessment. The primary endpoint of the study was to evaluate the change in estimated Glomerular Filtration Rate (eGFR) at 12 months in patients with Acute Tubular Necrosis (ATN), compared to a non-ATN control group. Outcomes such as graft function, patient survival, and graft survival were also measured at 12 months.
Results:
ATN was observed in 55 patients (87.3% male, mean age 36.29±10.67 years). Most received deceased donor grafts (74.5%), while 25.5% had living-related donors, with an average cold ischemia time of 6.35±4.19 hours. Etiologies included isolated reperfusion ischemic injury (80%), concurrent CNI toxicity (7.2%), concurrent C4d+ rejection (9.1%), concurrent graft pyelonephritis (1.8%), and C4d-negative ATN (1.8%). In early post-transplant period, patients with ATN exhibited a high incidence of delayed graft function occurring in (63.6%), followed by slow graft function in (21.8%) of cases, and immediate graft function in only (14.5%) of cases. At 1 year, ATN patients exhibited significantly impaired graft function (eGFR 79.26±22.67 mL/min) compared to non-ATN (n=204) patients (eGFR 87.86±26.61 mL/min, p=0.047). No significant difference was noted in outcomes between ATN patients with deceased donors and those with living donors (p>0.05). 10 patients (18%) died within 1 year of post-transplant period and 3 patients (5%) had graft loss.
Conclusions:
Irrespective of the Etiology, ATN significantly contributes to graft dysfunction at 1 year in both deceased and living donor transplants. This highlights the need for effective strategies to prevent and manage ATN to enhance long-term transplant success.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.