移植技術と研究

Acute Kidney Injury as a Risk Factor for Transplant Graft Failure

Abstract

Motonobu Nakamura, Shoko Horita, Masashi Suzuki, Osamu Yamazaki, Nobuhiko Satoh and George Seki

Acute kidney injury (AKI) has long-term biological effects on many organ systems and high mortality. Incomplete recovery of renal function from AKI is frequently observed, particularly when AKI is superimposed on chronic kidney disease (CKD), and this situation may further facilitate the progression of CKD. Patients with severe AKI in the intensive care unit typically have several failed extrarenal organ systems, including haemodynamic instability and respiratory failure. Consistent with these observations, AKI is associated with increased rates of graft failure and mortality after non-renal transplantation. For example, AKI is a common complication of liver transplantation and is associated with reduced patient and graft survival. AKI after lung transplantation also affects the clinical outcomes. The toxicity of calcineurin inhibitors, intraoperative hypoxemia, hypoperfusion due to diuretics overuse, and the use of antibiotics may be predisposing factors that leads to AKI after lung transplantation. While delayed graft function (DGF) caused by ischemic-reperfusion injury during the early phase of kidney transplantation affects graft function, pretransplantation AKI affecting donor kidneys may not have an adverse effect on long-term outcomes. Several biomarkers, such as gelatinase-associated lipocalin, have been evaluated for predicting DGF and long-term graft function; however, additional studies are required to establish the optimal use of these biomarkers. Recent studies also indicate that AKI during in the maintenance phase of kidney transplantation, frequently associated with sepsis and/or urinary tract infection, is a significant risk factor for graft failure. In this review, we focus on the impact of AKI on non-renal and renal transplant graft survival.