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Dialyse aktuell 2014; 18(8): 423-429
DOI: 10.1055/s-0034-1395946
Nephrologie
© Georg Thieme Verlag Stuttgart · New York

Akutes Nierenversagen und Nierentransplantation – Risikofaktoren und mehr

Acute kidney injury and renal transplantation – Risk factors and more
Bernd Krüger
1   V. Medizinische Klinik (Nephrologie, Hypertensiologie, Endokrinologie, Diabetologie, Rheumatologie) und Nierentransplantationszentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg (Klinikdirektor: Prof. Dr. Bernhard Karl Krämer)
,
Urs Benck
1   V. Medizinische Klinik (Nephrologie, Hypertensiologie, Endokrinologie, Diabetologie, Rheumatologie) und Nierentransplantationszentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg (Klinikdirektor: Prof. Dr. Bernhard Karl Krämer)
,
Peter Schnülle
1   V. Medizinische Klinik (Nephrologie, Hypertensiologie, Endokrinologie, Diabetologie, Rheumatologie) und Nierentransplantationszentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg (Klinikdirektor: Prof. Dr. Bernhard Karl Krämer)
2   Nierenzentrum Weinheim
,
Bernhard Karl Krämer
1   V. Medizinische Klinik (Nephrologie, Hypertensiologie, Endokrinologie, Diabetologie, Rheumatologie) und Nierentransplantationszentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg (Klinikdirektor: Prof. Dr. Bernhard Karl Krämer)
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Publication Date:
05 November 2014 (online)

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In gut selektionierten Einzelfällen können postmortale Spendernieren trotz bei Organentnahme bestehendem ANV/AKI mit guten Ergebnissen hinsichtlich der Transplantatfunktion und des Transplantatüberlebens transplantiert werden. Ein ANV/AKI ist unmittelbar nach Nierentransplantation auch bei guter Nierenfunktion des Spenders sehr häufig (> 90 %), da auch die schwerste Form des ANV/AKI entsprechend der verzögerten Transplantationsfunktionsaufnahme mit postoperativer Dialysenotwendigkeit innerhalb der ersten 7 Tage (DGF: Delayed Graft Function) bereits bei ca. 20–30 % der Nierentransplantationsempfänger nachweisbar ist. Risikofaktoren für das postoperative Auftreten eines ANV/AKI bzw. einer DGF umfassen u. a. ECD-Spender (erweiterte Spenderkriterien), lange kalte Ischämiezeit (CIT), hohes Spenderkreatinin, hohes Spenderalter, weiblicher Spender, Spenderatherosklerose, DCD-Spender (nach Herztod), Risikofaktoren des Empfängers wie männliches Geschlecht, Diabetes, Hypertonie, Atherosklerose, Dialysedauer, Retransplantation, PRA/HLA-Mismatch und Sirolimustherapie. Auch im Langzeitverlauf nach Nierentransplantation ist das Auftreten eines ANV/AKI häufig meist im Rahmen eines prärenalen ANV/AKI bei Flüssigkeitsverlusten (z. B. Diarrhöen), Medikamententoxizität (z. B. NSAID, CNI) und Infektionen (z. B. Urosepsis, Pneumonie).

In highly selected donors, post-mortal donor kidneys with pre-existing AKI may be used with good results regarding graft function and graft survival. AKI immediately after renal transplantation is very frequent (> 90 %) even with good donor renal function, given that the most severe grade of AKI (DGF: delayed graft function) that necessitates post-operative dialysis treatment within the first 7 days is present in about 20–30 % of renal transplant recipients. Risk factors for post-operative AKI or DGF comprise e. g. ECD donors, long cold ischemia time (CIT), high donor creatinine, high donor age, female donor, donor atherosclerosis and DCD donor. Recipient risk factors are male sex, diabetes, hypertension, atherosclerosis, dialysis duration, retransplantation, high PRA/HLA mismatch and sirolimus use. Also in long-term follow-up after renal transplantation and the incidence of AKI remains considerably high most often related to pre-renal AKI with fluid loss (i. e. diarrhea), nephrotoxicity (NSAIDs, CNI) and infections (urosepsis, pneumonia).

Key words

acute kidney injury - renal transplantation - donor - delayed graft function - infection
 

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