Early Post-transplant Renal Functions Predict Incidence of Acute Rejection in Kidney Transplantation

Objectives: After renal transplantation, a remarkable improvement of impaired patient’s kidney function is often observed. Preserving improved kidney function ensures long-term renal allograft survival. However, there are different risk factors; the acute rejection is the major risk factor. Therefore, the aim of the present study was to examine renal function within the first six months as independent variables in predicting long-term survival and incidence of acute rejection.

Methods: Fifty-three patients who underwent kidney transplantation in 2016 and 2017 in King Abdulaziz Medical City- National Guard were evaluated consecutively1 and 2-month pre-transplant up to six months’ post-transplant. Time course of changes in kidney functions; measurements of serum creatinine (Scr), blood urea nitrogen(BUN), albumin, calcium, sodium and potassium were recorded. Estimated glomerular filtration rate (eGFR) and anion gap (AGAP) were also reported. In addition, age, anthropometric factors and causes of ESRD were analyzed.

Results: Lower level of calcium was observed in 40% of patient’s two-month pre-transplantation and 69% of patients one month before. Normalization of calcium was achieved in all patients starting from second month post-transplantation. All patients presented elevated serum potassium level in pre-transplant months, however, renal transplant normalize potassium level starting from first month. A remarkable higher level of serum BUN was observed in all pre-transplant patients followed by dramatically decreased after renal transplant for first four months and remain in normal level starting from month 5. Likewise, serum creatinine was highly elevated in all pre-transplant patients. A profound reduction in serum creatinine started from month 1 post-transplant and normalizes at month 4. Moreover, both eGFR and AGAP were kept in normal level immediately after renal transplantation. All patients with early acute rejection during mean follow-up period have a remarkable elevated level of serum creatinine and profound decrease in eGFR starting from first month. While a significant higher level of serum BUN observed in fifth month only and serum albumin in third month.

Conclusion: Significant elevation of serum creatinine and reduction in eGFR starting from first month were associated with post-transplanted patients with early acute rejection. The clinical use of eGFR and serum creatinine may aid in predicting incidence of early acute rejection.