# Frequency and Outcomes of Acute Kidney Injury in the First Month Post-transplant: A Study on Renal Transplant Recipients in a Resource-Limited Country

## TL;DR

This study found that nearly half of kidney transplant patients in Pakistan experienced acute kidney injury within the first month, but most cases resolved without long-term damage.

## Contribution

The study provides insights into AKI incidence and outcomes in renal transplant recipients in a resource-limited setting.

## Key findings

- 41.5% of 195 renal transplant patients developed acute kidney injury (AKI) within the first month post-transplant.
- Most AKI cases were self-limiting and resolved to baseline graft function.
- Common causes included dehydration, urinary tract infections, and drug-induced injury.

## Abstract

Objective

The study aimed to determine the incidence of acute kidney injury (AKI) in renal transplant recipients in the first month after transplant. The number of AKI episodes per patient and their outcome on renal graft function were also determined.

Material and methods

It is a retrospective study that took place in the Nephrology Department of Pakistan Kidney and Liver Institute and Research Center (PKLI & RC), Lahore, Pakistan. A total of 195 patients aged 18-70 years who underwent kidney transplant surgery at PKLI & RC, Lahore, were selected in this cohort that underwent renal transplants from 31st January 2024 to 31st December 2024. One month post-transplant course was followed by obtaining serum creatinine level values. Data was analyzed using Microsoft Excel (Microsoft® Corp., Redmond, WA, USA).

Results

A total of 81 out of 195 patients (41.5%) had AKI within the first 30 days following a renal transplant. Seventy patients experienced AKI once (86.4%), meanwhile, 11 patients (13.5%) had two episodes of AKI within the first 30 days. Staging done as per Kidney Disease Improving Global Outcomes (KDIGO) guidelines showed that 73 patients had stage I AKI (90.1%). Three patients had stage II AKI (3.7%), while five patients had stage III AKI (6.2%). The most common cause was found to be pre-renal (dehydration) in 24 patients out of 81 (29.6%) and followed by a urinary tract infection in 23 patients (28.3%). Twenty patients (24.6%) had drug-induced AKI; there was calcineurin inhibitor (CNI) toxicity in 8.6% and acute tubular necrosis (ATN) in 7.4% of patients. One patient had acute antibody-mediated rejection (ABMR). Most cases of AKI were found to be self-limiting, with complete resolution to baseline renal allograft function.

Conclusion

Even though most episodes of AKI completely resolved to baseline creatinine, it is pivotal to timely diagnose and treat AKI in post-renal transplant patients. If left untreated, there can be a worsening of graft function and overall outcome of the transplant.