[Acute tubular necrosis in kidney transplantation].
BACKGROUND
The acute tubular necrosis (ATN) is common after kidney transplantation. Acute tubular necrosis (ATN) is multifactorial and represents one of the main causes of the delayed graft function. Its impact on graft and patients survival is documented.


OBJECTIVE
To study the prevalence of the ATN in kidney transplanted patients, the acute rejection rate and their impact on the graft and the patient survival.


METHODS
We retrospectively studied the frequency of ATN, its causes and its impact on patient and graft survival in 255 kidney transplanted patients between 1986-2006.


RESULTS
Thirty-nine patients had ATN (15.29%). They are 25 men and 14 women with mean age of 30.1 ± 12.6 years (8-61) followed for an average of 98 ± 61.76 months. The majority was treated by hemodialysis (79.48%) and half of them were transplanted from kidney of deceased donor. All patients received anti lymphocyte serum and the majority anticalcineurins (69.23%). The outcome was favorable in 26 patients (66.66%) with recovery of diuresis and normalization of renal function after 6 weeks on average. An acute rejection was diagnosed in 21 patients (53.48%). The mean creatinine at 1, 5 and 10 years was 135.3, 159.9 and 121.4 μmol / l. Eight patients had creatinine ² 130 μmol / l at 10 years. Ten patients died from infectious and cardiovascular causes. By comparing the 2 groups ATN + and ATN - we found a statistically significant correlation between ATN and cold ischemia (10 ± 10.9 vs 1.2 ± 4.7 hours, p <0.0001) and the interval between the start of dialysis and transplantation (42.18 ± 38.44 vs. 31.1 ± 25.2 months, p= 0.02). No statistical correlation was found between the ATN and gender, age of recipient and donor, warm ischemia, acute rejection, chronic rejection and graft and patient survival at 1, 5 and 10 years.


CONCLUSIONS
The ATN is more common among transplanted patients from deceased donors. It had good evolution in the majority of cases and it's correlated to cold ischemia and duration of dialysis. Finally, it has no impact on patients and graft survival.
Universite Tunis, El Manar, Tunisie.
Mondher
M
Ounissi
Taher
T
Gargah
Samia
S
Barbouch
Karima
K
Boubaker
Mejda
M
Cherif
Mohamed Mongi
MM
Bacha
Ezzeddine
E
Abderrahim
Fethi
F
Ben Hamida
Rachid
R
Lakhoua
Taieb
T
Ben Abdallah
Adel
A
Kheder
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007673:Kidney Cortex Necrosis / Q000453:epidemiology* / Q000209:etiology*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult