Abstract: SA-PO0692
Effect of Early Nonrejection AKI on Pediatric Kidney Transplant Outcomes
Session Information
- Pediatric Nephrology: Transplantation, Hypertension, AKI, Genetics, and Developmental Diseases
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Author
- Barbera, Andrew Jason, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
Background
Advancements in immunosuppression have improved acute rejection rates and allograft survival for pediatric kidney transplant recipients. However, non-rejection acute kidney injury (NR-AKI) caused by dehydration and infections (among other causes) remains common. Although many consider NR-AKI to be less significant compared to acute rejection (R-AKI), the impact of NR-AKI on transplant outcomes remains understudied. This study aims to evaluate the impact of NR-AKI vs. R-AKI on allograft function and allograft survival in pediatric kidney transplant recipients.
Methods
We performed a single-center retrospective cohort study on 228 children that received a kidney transplant between 2005 and 2022 and had over 10 years of follow-up. The primary exposure was AKI during the first two years post-transplant, defined using KDIGO criteria and considered as all-cause AKI as well as NR-AKI and R-AKI subgroups. The primary outcomes were subsequent acute rejection, and allograft survival.
Results
164/228 (72%) of patients experienced at least one episode of all-cause AKI in the first two years post-transplant, with 125/228 (54%) experiencing only NR-AKI and 39/228 (17%) experiencing at least one R-AKI episode. Black patients (P=0.001) and teenagers (P=0.035) were at higher risk for all-cause AKI. Among the 33% with 10-year allograft failure (n=76), 67% of patients had at least one R-AKI, 32% had only NR-AKI, and 17% had no AKI (P<0.001 for trend). NR-AKI was not associated with late acute rejection but still associated with a 2.2-fold increased risk of graft failure compared to those without AKI (P<0.001; Figure 1).
Conclusion
The incidence of NR-AKI was 3-fold higher than R-AKI in the early post-transplant period in children. NR-AKI was associated with higher rates of graft failure even in patients that never experienced acute rejection. These findings highlight the relevance of NR-AKI and the need for studies linking NR-AKI with allograft failure.
Funding
- Other NIH Support