Post Kidney Transplant Immediate Complications: Delayed Graft Function and Wound

Abstract

Delayed graft function (DGF) is the need for dialysis in the first 7 days after kidney transplant, and is a form of acute kidney injury. DGF is a consequence of ischemia/reperfusion injury, and is most common in deceased donor kidney transplant recipients with an incidence of 25% in brain dead donors and 40% in donor after cardiac death. DGF begins to recover within the first 20 days post-transplant in most recipients. DGF that persists beyond 90 days is primary nonfunction. Risk factors for DGF include donor age, BMI, hypertension, death due to stroke or anoxia, terminal serum creatinine, cold ischemia time, warm ischemia time, recipient BMI, male gender, black ethnicity, previous transplant or blood transfusion, number of HLA mismatches and duration of dialysis. DGF is associated with increased 30-day readmission rate, poorer kidney allograft function, risk for rejection and shorter patient and allograft survival. Management of DGF includes close monitoring of graft function, optimizing immunosuppression and dialyzing as indicated. Post-transplant wound complications includes superficial or deep wound infection, fascial dehiscence and incisional hernia. Kidney transplant is a clean-contaminated case as urine may spill into the operative field. Immunosuppression, obesity, diabetes, nutrition, location of the incision, uremia, low functional status, reoperation and DGF are risk factors for wound complications. Wound infections usually occur in the first post-transplant month. Hernias develop later after transplant.