Kidney Week

Abstract: TH-PO1021

Rethinking Surgical Risk: Postoperative Allograft Outcomes in Kidney Transplant Recipients Are Comparable to Those in the General Population

Session Information

• Transplantation: Clinical - Outcomes, Malignancy, and Pathology
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Ghimire, Anukul, University Health Network, Toronto, Ontario, Canada

Anukul Ghimire, MD, MS, FASN

• Landsberg, Adina, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada

Adina Landsberg, MD

• Scory, Tayler D., University of Calgary, Calgary, Alberta, Canada

Tayler D. Scory, MSc

• Clarke, Alix, University of Calgary, Calgary, Alberta, Canada

Alix Clarke, MSc

• Hemmelgarn, Brenda, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada

Brenda Hemmelgarn, MD, PhD

• Ronksley, Paul E., University of Calgary, Calgary, Alberta, Canada

Paul E. Ronksley, PhD

• James, Matthew T., University of Calgary, Calgary, Alberta, Canada

Matthew T. James, MD, PhD

• Tonelli, Marcello, University of Calgary, Calgary, Alberta, Canada

Marcello Tonelli, MD, MS, MSc

• Kim, Joseph, University Health Network, Toronto, Ontario, Canada

Joseph Kim, MD, PhD, MBA

• Lam, Ngan, University of Calgary, Calgary, Alberta, Canada

Ngan Lam, MD, MSc

• Harrison, Tyrone, University of Calgary, Calgary, Alberta, Canada

Tyrone Harrison, MD, PhD

Background

Previous studies characterizing post-operative changes in allograft function among kidney transplant recipients (KTR) have been limited by selection bias and restrictions in types of surgeries included. We compared the magnitude of kidney function change following various surgical procedures between prevelant KTR and the general population in a population-based matched cohort study.

Methods

In this retrospective population-based cohort study, we 1:1 matched prevalent adult KTR who underwent a non-cardiovascular surgery between 2005 and 2021 in Alberta, Canada, with controls based on propensity scores that included surgical, patient, and kidney-related variables. We estimated (1) changes in estimated glomerular filtration rate (eGFR) from baseline to 30 days and 12 months after surgery, (2) the risk of needing acute dialysis within 30 days of surgery and (3) developing any stage 1-3 acute kidney injury (AKI) following surgery.

Results

We included 1,216,182 surgical procedures performed on KTR (n=6,383) and controls (n=1,209,799). After matching, 6,114 pairs were included. Skin and soft tissue (n= 3,814, 31%) procedures were the most common surgeries performed. There were no significant differences in the maximum eGFR change (all in mL/min/1.73m²) between KTR and controls (-0.20, 95% CI -0.81, 0.42, p=0.53), change in preoperative to first outpatient eGFR (+0.25, 95% CI, -0.19, 0.68, p=0.27), change in preoperative to lowest outpatient eGFR within 30 days (-0.27, 95% CI -0.95, 0.40, p=0.43) and change in preoperative to 12 months postoperative eGFR (0.27, 95% CI -0.87, 1.42, p=0.64). The odds of needing acute dialysis within 30 days of surgery, developing any stage AKI, and death in 30 days or 1 year after surgery were not different between the KTR and control groups. Although KTR had a 14% higher relative risk of the composite of death, >=40% decline in eGFR, and re-transplant in 1 year, this was not statistically significant (OR 1.14, 95% CI 0.99, 1.31, P= 0.06).

Conclusion

KTR do not have an increased risk of post-operative GFR decline, AKI, or need for dialysis compared to the general population. These findings have implications for shared decision-making and counselling around risks associated with surgery. Further work is needed to develop risk-prediction models for post-surgical AKI among KTR and to stratify outcomes by type of surgery.