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Kidney Week

Abstract: FR-PO1129

AKI in Renal Transplant Recipients Undergoing Cardiac Surgery

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical


  • Hundemer, Gregory L., The Ottawa Hospital, Ottawa, Ontario, Canada
  • Srivastava, Anand, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Sharma, Shreyak, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
  • Kellum, John A., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Riella, Leonardo V., Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
  • Leaf, David E., Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

Acute kidney injury (AKI) is a key risk factor for chronic kidney disease in the general population, but few studies have assessed AKI among renal transplant recipients (RTRs). Moreover, most studies of AKI among RTRs focused on AKI occurring in the immediate peri-transplant period, included heterogenous (or unknown) causes of AKI, and relied on diagnostic/billing codes rather than granular patient-level data. We conducted a detailed investigation into the incidence, severity, and risk factors for AKI following cardiac surgery among RTRs.


We queried electronic medical records of >20,000 cardiac surgeries at two major academic medical centers in Boston, MA, from 2005-2018. We identified 83 RTRs and matched them 1:1 to non-RTRs by age, preoperative eGFR, and type of surgery. We used multivariable logistic regression to adjust for potential confounders. AKI and its severity were defined according to KDIGO criteria.


RTRs had a higher rate of AKI following cardiac surgery compared to non-RTRs (46% vs. 28%; adjusted OR 2.77 [95% CI, 1.36 to 5.64]). Among RTRs, deceased donor (DD) vs. living donor (LD) status, as well as higher vs. lower preoperative calcineurin inhibitor (CNI) trough levels, were associated with higher rates of AKI (57% vs. 33% for DD-RTRs vs. LD-RTRs, P=0.03; 73% vs. 36% for RTRs with higher vs. lower CNI trough levels, P=0.02). The combination of both risk factors (DD status and higher CNI trough level) had an additive effect (88% AKI incidence among patients with both risk factors vs. 25% incidence among RTRs with neither risk factor, P=0.004).


RTRs have a higher risk of AKI following cardiac surgery compared with non-RTRs with otherwise similar characteristics. Among RTRs, DD-RTRs and those with higher preoperative CNI trough levels are at highest risk.


  • NIDDK Support