Abstract
Introduction
Patients with solid organ transplant have been shown to have increased risk of complications following TKA compared to non-transplant patients. The risk of AKI in KTx is reported to be as high as 15.6 % and associated with increased morbidity, and length of stay (LOS). Our aim was to determine the incidence of AKI in KTx undergoing primary and revision TKA and to identify risk factors for its occurrence and its effect on allograft function 1 year postoperatively.
Methods
Using the orthopedic and transplant databases we designed a case-control study of 82 patients undergoing 101 TKA between 2000 and 2018 at our institution. The average age at surgery was 65 years (range 35–83); 58% male and 98% white. AKI was defined per KIDGO guidelines.
Results
The incidence of AKI was 7 % after primary and revision TKA. Median baseline kidney function (eGFR) was lower in the AKI group (33 vs. 53 ml/min, p=0.003). All AKI were stage 1 as per AKIN criteria. LOS was 4.9 vs. 3.5 days for those with and without AKI (p= 0.04). There was no significant difference between anesthesia time, pressor requirements, estimated blood loss, transfusion, or amount of fluid administered between the 2 groups. At one year, there was a drop in eGFR in AKI patients compared to non-AKI patients (− 14 vs. 0 ml/min (p=0.042).
Discussion
The incidence of AKI after TKA in KTx was 7 % in this cohort and associated with longer hospitalization. AKI occurred in patients with lower baseline eGFR and there were no other identified risk factors. Despite the injury being mild, AKI in KTx was associated with greater decrease in eGFR at 1 year prompting the need to identify patients preoperatively at greatest risk.
For figures, tables, or references, please contact authors directly.
