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Determinants of Outcomes of Acute Kidney Injury: Clinical Predictors and Beyond
 
 
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Review

Acute Kidney Injury (AKI) before and after Kidney Transplantation: Causes, Medical Approach, and Implications for the Long-Term Outcomes

by
Alessandra Palmisano
1,*,
Ilaria Gandolfini
1,2,
Marco Delsante
1,2,
Chiara Cantarelli
1,
Enrico Fiaccadori
1,2,
Paolo Cravedi
3 and
Umberto Maggiore
1,2
1
Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
2
Nephrology Unit, Parma University Hospital, 43126 Parma, Italy
3
Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2021, 10(7), 1484; https://doi.org/10.3390/jcm10071484
Submission received: 15 February 2021 / Revised: 28 March 2021 / Accepted: 29 March 2021 / Published: 2 April 2021
(This article belongs to the Special Issue New Pathogenetic Mechanisms and Therapeutic Challenges in Acute Kidney Injury)
Versions Notes

Abstract

Acute kidney injury (AKI) is a common finding in kidney donors and recipients. AKI in kidney donor, which increases the risk of delayed graft function (DGF), may not by itself jeopardize the short- and long-term outcome of transplantation. However, some forms of AKI may induce graft rejection, fibrosis, and eventually graft dysfunction. Therefore, various strategies have been proposed to identify conditions at highest risk of AKI-induced DGF, that can be treated by targeting the donor, the recipient, or even the graft itself with the use of perfusion machines. AKI that occurs early post-transplant after a period of initial recovery of graft function may reflect serious and often occult systemic complications that may require prompt intervention to prevent graft loss. AKI that develops long after transplantation is often related to nephrotoxic drug reactions. In symptomatic patients, AKI is usually associated with various systemic medical complications and could represent a risk of mortality. Electronic systems have been developed to alert transplant physicians that AKI has occurred in a transplant recipient during long-term outpatient follow-up. Herein, we will review most recent understandings of pathophysiology, diagnosis, therapeutic approach, and short- and long-term consequences of AKI occurring in both the donor and in the kidney transplant recipient.
Keywords: acute kidney injury; kidney transplantation; delayed graft function; donor selection acute kidney injury; kidney transplantation; delayed graft function; donor selection

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MDPI and ACS Style

Palmisano, A.; Gandolfini, I.; Delsante, M.; Cantarelli, C.; Fiaccadori, E.; Cravedi, P.; Maggiore, U. Acute Kidney Injury (AKI) before and after Kidney Transplantation: Causes, Medical Approach, and Implications for the Long-Term Outcomes. J. Clin. Med. 2021, 10, 1484. https://doi.org/10.3390/jcm10071484

AMA Style

Palmisano A, Gandolfini I, Delsante M, Cantarelli C, Fiaccadori E, Cravedi P, Maggiore U. Acute Kidney Injury (AKI) before and after Kidney Transplantation: Causes, Medical Approach, and Implications for the Long-Term Outcomes. Journal of Clinical Medicine. 2021; 10(7):1484. https://doi.org/10.3390/jcm10071484

Chicago/Turabian Style

Palmisano, Alessandra, Ilaria Gandolfini, Marco Delsante, Chiara Cantarelli, Enrico Fiaccadori, Paolo Cravedi, and Umberto Maggiore. 2021. "Acute Kidney Injury (AKI) before and after Kidney Transplantation: Causes, Medical Approach, and Implications for the Long-Term Outcomes" Journal of Clinical Medicine 10, no. 7: 1484. https://doi.org/10.3390/jcm10071484

APA Style

Palmisano, A., Gandolfini, I., Delsante, M., Cantarelli, C., Fiaccadori, E., Cravedi, P., & Maggiore, U. (2021). Acute Kidney Injury (AKI) before and after Kidney Transplantation: Causes, Medical Approach, and Implications for the Long-Term Outcomes. Journal of Clinical Medicine, 10(7), 1484. https://doi.org/10.3390/jcm10071484

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