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Abstract: TH-PO174

Clinical Outcomes of Adult Kidney Transplant Recipients with Post-Transplant Metabolic Acidosis: A Retrospective Cohort Study

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Author

  • Isidro, Erika bianca Villazor, St. Luke's Medical Center, Quezon City, Philippines
Background

Metabolic acidosis as defined as serum bicarbonate of <22 mmol/L is commonly seen in patients with advanced chronic kidney disease, and is observed among Kidney transplant recipients (KTRs) due to maladaptive changes during early post-transplant causing subacute kidney injury despite preserved estimated glomerular filtration rate. Post-transplant metabolic acidosis is potentially an early marker of chronic allograft nephropathy, and eventual graft loss. However, graft survival is not well studied due to lack of periodic determination of serum bicarbonate post-transplant. This study aims to determine clinical outcome of graft loss among patients with post-transplant metabolic acidosis.

Methods

This is a single-centered retrospective cohort study, which included 132 eligible subjects from January 1995-December 2012 at the St. Luke’s Medical Center, Quezon City. Laboratory measurements were determined at 12 months post-transplant, which included serum bicarbonate, creatinine, and proteinuria. Clinical outcomes were determined as graft loss, either by death or death censored graft failure, based on follow-up records.

Results

A total of 132 recipients were analyzed for baseline characteristics according to serum bicarbonate at 12 months post-transplant. The low serum bicarbonate (<22 mmol/L) group included 26 patients, with an incidence rate of 19.7%. Risk factors for metabolic acidosis include: eGFR of 15- 30 ml/min, deceased donor status, presence of one DR mismatch, acute rejection, presence of proteinuria, and use of alkalinizing agents. Graft loss, death, and death censored graft failure were not significantly associated with post-transplant metabolic acidosis, with the following risk ratios for graft loss (HR=2.293, 95% CI 0.849-6.191, p=NS), mortality (HR=1.885, 95% CI 0.311 -11.436, p=NS), and death censored graft failure, (HR=2.502, 95% CI 0.759-8.246, p=NS). The mean allograft survival with metabolic acidosis is 124.8 months, compared with 134.1 months in the group without metabolic acidosis.

Conclusion

Post-transplant metabolic acidosis has fairly high incidence rate of 19.7%. Graft loss, death, and death censored graft failure were not significantly associated with post-transplant metabolic acidosis. Periodic monitoring of serum bicarbonate is recommended to yield a well-represented large prospective cohort study in the future.