Introduction: The incidence of acute kidney injury (AKI) and its mortality is higher in low-middle-income countries (LMICs) compared to high-income countries. In LMICs, 77% of AKI is community-acquired e.g. acute gastroenteritis, endemic infections (malaria, dengue), and obstetrical complications.  Additionally, poor health facilities, and delayed presentation result in AKI severity, requiring dialysis, and resultant high mortality.  Renal transplant recipients can develop community-acquired AKI in addition to AKI due to transplant-specific insults like immunological injury, drug toxicities, and surgical complications.  This paper presents renal allograft and patient outcomes following AKI that required dialysis therapy in the setting of a low-income country where community-acquired infections are common and health facilities are inadequate.
Patient and Method: We analyzed the medical records of 3000 first living donor renal transplants for AKI admission requiring dialysis therapy performed between 1st January 2008 to 2017. A total of 154 patients were identified. Patients ≤ 15 years of age were excluded. Donor, recipient, and transplant variables were recorded along with the cause of AKI and patients were followed up to 12 months post-AKI event. Statistical analyses were performed using SPSS version 22.
Results: Of the 3000 transplants, 154(5.1%) patients were admitted with AKI requiring dialysis therapy. The cause of AKI was infectious in 77(50%) and non-infectious in 77(50%) patients. The main cause of infectious AKI was urinary tract infection (UTI), which was found in 47 (30.5%) and non-infectious AKI was plasma cell-rich rejection in 35 (22.7%). Of the 154 patients, 115(74.7%) were alive at discharge and 71(61.7%) were dialysis free. At 3 months follow-up, out of 71 dialysis-free patients, 11(15.5%) had complete recovery, 48(67.5%) had partial recovery, 6(8.5%) had no recovery, and 6(8.5%) required dialysis.  At 1 year, of the 154, 98(63.6%) patients were alive and 42(42.9%) were dialysis free. The risk of in-hospital mortality was significantly higher in the infectious group as compared to the non-infectious group (82%vs39%, OR=6.64,p<0.001). Dialysis dependency at discharge was significantly less in the infectious group as compared to the non-infectious group (2.27%vs61%, OR=0.009,p<0.001)
Conclusion: AKI in renal transplant recipients has adverse effects resulting in a mortality rate of 36.4% at 1 year. Of the 98 patients alive at 1 year, 56 (57.1%) were on dialysis. Graft and patient outcomes in our region are comparable to other regions of the world. Possible reasons are younger transplant patients with fewer comorbidities.