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Delayed Graft Function Management — ESENeph MCQ

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ModerateTransplantationDelayed Graft Function ManagementESENeph

A 48-year-old kidney transplant recipient develops delayed graft function (DGF) – the transplanted kidney is not producing urine 48 hours post-transplant. He received a deceased donor kidney with 22 hours cold ischaemia time. Biopsy shows ATN. What is the management?

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Correct answer: D — Supportive management with dialysis as needed; DGF from ATN is usually recoverable; maintain immunosuppression and monitor for rejection

Delayed graft function (need for dialysis within the first week post-transplant) occurs in 20-40% of deceased donor transplants. The most common cause is ischaemia-reperfusion injury causing ATN. Risk factors include prolonged cold ischaemia time, DCD donors, and recipient factors. Most DGF from ATN recovers within 1-4 weeks. Immunosuppression must be maintained to prevent rejection (rejection risk is increased during DGF). Biopsy should be performed if DGF persists >7-10 days or if rejection is suspected.

Reference: KDIGO 2009 – Transplant Guideline; Irish et al 2003 – DGF Risk Factors