Kidney Allograft Function and Its Determinants at 12 Months Post Transplantation in Kenya

Abstract

Background: Kidney transplantation is a treatment of choice for most patients with End Stage Kidney disease. Kidney allograft function at one year provides prognostic information and is influenced by donor, recipient and other factors. These determinants have not been described in Kenya. This study aimed at assessing the kidney allograft function status at one-year post-transplant and describing risk factors of allograft dysfunction. This information shall help clinicians identify patients at risk of poor function and prioritize early interventions. This shall improve patient outcomes and ensure longevity of the transplant program. Objective: To assess kidney allograft function and its determinants in KTRs transplanted at Kenyatta National Hospital and Aga Khan University Teaching Hospital at 12 months post-transplant over 10 years. Methods: This was a retrospective cohort of all available charts at two transplant centers (Kenyatta National Hospital and Aga Khan University Hospital) of a period of ten years. Selected demographic, clinical and biochemical data of both the recipients and donors were extracted by using a questionnaire. Data entry was done using Kobo tool box and exported to R Software for analysis. Missing data was imputed by multiple imputation methods, Bivariate analysis was done to describe valuables associated with allograft dysfunction. Mixed effect logistic regression model was used to establish determinants of allograft dysfunction at one year. Level of significance was 0.05. Results: Two hundred and forty patients were transplanted over the 10-year period. Of these only 150 charts were available for analysis. The donor median age was 33 years (IQR (28, 39)) with 59% of them being male. Eighty five percent of donors were first degree relatives. Majority of recipients were male (71%) with a median age of 36 years. The prevalence of allograft dysfunction was 22.6%. Pre transplant blood transfusion was common (59%). Patients with allograft dysfunction were more likely to be male (p value = 0.011) and married (p value = 0.032). We observed a higher rate of pre-transplant blood transfusion (p value = 0.016), receiving pulse therapy with methyl prednisone (p value <0.001) and were more likely to have been diagnosed with AKI in the first 2 months after transplantation (p value < 0.001). Also, had higher creatinine levels at discharge, one month, three months, 6 months and had a higher calculated average of annual creatinine (all with p value < 0.001). A longer duration in surgery more than 3.5 hours was more prevalent in patients with allograft dysfunction (p value = 0.04). Acute Kidney Injury within the first year ((P value 0.008 Adjusted Odds Ratio (AOD) of 13.2 (95% CI 1.96-88.05)) and transplant surgery of more than 3.5 hours ((P value 0.018 AOD 5.06 (95% CI 1.32-19.34) were associated with kidney allograft dysfunction at 12 months. Conclusion: 1 in every 5 kidney transplant recipients had allograft dysfunction at 12 months, this was associated with development of acute kidney injury post-transplant and transplant surgery of more than 3.5 hours.