Delayed Graft Function Cold Ischaemia — ESENeph MCQ

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EasyTransplantationDelayed Graft Function Cold IschaemiaESENeph

A 60-year-old man has a kidney transplant from a deceased donor with 18 hours cold ischaemia time. On day 3 post-transplant, his creatinine has not fallen from the pre-transplant level. He is anuric. Ultrasound shows normal transplant perfusion and no hydronephrosis. Tacrolimus trough is 8 ng/mL (therapeutic). What is the most likely diagnosis?

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Correct answer: B — Delayed graft function

Delayed graft function (DGF) is defined as the need for dialysis within the first week post-transplant. It occurs in 20-40% of deceased donor transplants and is strongly associated with prolonged cold ischaemia time (>18 hours is a significant risk factor), donor quality (DCD > DBD), and recipient factors. The mechanism is ischaemia-reperfusion injury causing acute tubular necrosis. Normal ultrasound perfusion excludes vascular thrombosis; no hydronephrosis excludes ureteric obstruction. Management is supportive with continued immunosuppression (at protocol doses) and dialysis support while awaiting graft recovery, which typically occurs within 1-3 weeks. A transplant biopsy may be indicated if recovery is delayed beyond 7-10 days to exclude rejection.

Reference: Yarlagadda et al 2009 – DGF Risk Factors; UKKA/BTS 2018 – Transplant Guidelines