KEY FACTS
Terminology
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Need for dialysis or failure of serum creatinine to halve in 1st week after transplantation
Imaging
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Clinical diagnosis with no specific imaging findings
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Renal transplant may be edematous
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Ultrasound with Doppler serves to exclude other causes of renal transplant dysfunction
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Look for hemorrhage, vascular thrombosis, or hydronephrosis
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Resistive indices may be elevated or there may be absence of diastolic flow
Pathology
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21% incidence in deceased donor transplantation
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2-5% after living donor transplantation
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Most common cause is acute tubular necrosis: 70-90%
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Risk factors
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Donor age, harvest injury, preservation
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Injury at procurement, organ preservation methods, warm and cold ischemia time
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Clinical Issues
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Present with oliguria, lack of renal function
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Delayed graft function has significant impact on long-term graft and patient survival
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Increased incidence of acute rejection
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May be complicated by vascular thrombosis
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Treatment is supportive with dialysis as indicated
Scanning Tips
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Determine vascular patency, exclude ureteral obstruction and collections
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Use ultrasound to guide renal transplant biopsy
