Factors associated with rejection of renal transplant patients in the Emergency Department

Abstract

Objective: Renal transplantation is the most effective treatment for the end-stage kidney disease. Increased number of renal transplant patients lead to a rise in the acute presentations of these patients to emergency departments (EDs) in recent years. The most important problem for these patients is ‘rejection’. We aimed to determine the factors to predict a possible rejection in patients with kidney transplantation in our study.
Methods: This retrospective case control study was conducted in the Akdeniz University Hospital ED with the transplant patients presented with any complaint. Clinical features of the patients diagnosed with rejection were determined. Forty patients were selected as the control group from the patients without rejection and who had similar demographics, such as age, sex and complaints with the rejection group. Nine parameters detected to prescribe rejection were compared between the groups. All data were entered in SPSS 15.0 for statistical analysis.
Results: There were 20 patients in the rejection group and 40 patients in the control group. There were no significant differences found between the groups for complaints. There was no significant difference found between the donors, presence of hypertension, concordance of blood type, Rh and HLA. The rate of diabetic patients were higher in the rejection group (25% versus 5%, p=0.036). Use of sirolimus (p=0.035) and non-compliance with cyclosporine (p=0.009) was significantly higher in the rejection group. The increase of creatinine value compared to the last known value was higher in the rejection group (p=0.000).
Conclusions: Time since transplantation, presence of DM, use of sirolimus or non-compliance with cyclosporine and high creatinine levels are considered as risk factors in patients with kidney transplantation for predicting rejection in the ED.