063 ACUTE KIDNEY INJURY FOLLOWING KIDNEY TRANSPLANTATION DUE TO DELAYED GRAFT FUNCTION AND RENAL ALLOGRAFT THROMBOSIS ACCOMPANIED BY FLUID OVERLOAD

Introduction
Kidney transplantation has been the chosen modality for treating patients with end-stage renal disease (ESRD), because it offers longer survival than dialysis therapy in almost all groups of patients. Delayed graft function (DGF) and renal allograft thrombosis are some of the complications that arise following kidney transplantation, mostly due to ischemia-reperfusion injury and immunological response, which can lead to acute kidney injury (AKI).

Objective
A case on a 69 years old woman who had undergone kidney transplantation 6 days earlier, was admitted to the ICU due to shortness of breathing. She experienced desaturation and unstable hemodynamic; then subsequently intubated, and required hemodynamic supports. Findings showed DGF, renal allograft vein thrombosis, AKI, pulmonary edema, and sepsis. Treatments were performed to overcome AKI, fluid overload and infections on this patient.

Methodology
We did prospective observational descriptive analysis on this patient. Graft thrombosis was corrected by administering heparin. Fluid removal was conducted through diuretic administration and hemodialysis to reach negative cumulative fluid balance. Broad-spectrum antibiotic, supportive therapy (blood glucose control, adequate fluid status, nutrition, transfusion), and temporary withdrawal of immunosuppressive drugs were done in dealing with sepsis.

Results
On the ninth day of treatment in ICU, the patient improved with urine production more than 1 ml/kg/h and stable hemodynamic without support. Microcirculatory parameters such as lactate and ScvO2 were normal. Clinical features and supporting data showed resolving of infection. Doppler ultrasound of allograft kidney no longer showed signs of DGF or thrombosis. Finally, the patient was extubated on the thirteenth day in ICU care.

Conclusion
Ischemia-reperfusion injury, immunological impairment and hypercoagulable state have contributed to the mechanism of DGF and thrombosis. Furthermore, both DGF and thrombosis play a role in causing AKI, also resulting in fluid overload which can lead to the impairment of gas exchange and organ perfusion. Evaluation and treatment of causing factor and effect due to transplant AKI should be done to prevent further damages, facilitate kidney function recovery, and avoid graft failure.