most commonly transplanted organ
Immediate (0-1 week)
Acute Tubular Necrosis
May be post-ischemic, commonly effecting both the proximal tubules and the thick ascending limb. Or it may be immunosupresive drug induced and only effect the proximal tubules.  Granular "muddy brown asts" seen on urinalysis result from death and sloughing of tubular cells.
Antibody mediated rejection
Results from donor specific antibodies including as ABO isoagglutinins.
Usually results in graft loss within 24 hours.
Embolization and Thrombosis
May arise with or without rejection
May result from hypotension, anastomotic stenosis, arterial dissection, kinking of transplanted artery, or angulation of the vein
Calcium Oxalate deposition
Delayed graft function
This is defined as renal failure persisting after transplantation necessitating dialysis.  It my be due to post-ischemic acute tubular necrosis, volume depletion, or volume depletion.
Urinary bladder dysfunction
This complication is especially common in diabetics and may cause hydronephrosis
May be post-ischemic, commonly effecting both the proximal tubules and the thick ascending limb. Or it may be immunosupresive drug induced and only effect the proximal tubules.  Granular "muddy brown asts" seen on urinalysis result from death and sloughing of tubular cells.
Results from donor specific antibodies including as ABO isoagglutinins.
Usually results in graft loss within 24 hours.
May arise with or without rejection
May result from hypotension, anastomotic stenosis, arterial dissection, kinking of transplanted artery, or angulation of the vein
This is defined as renal failure persisting after transplantation necessitating dialysis.  It my be due to post-ischemic acute tubular necrosis, volume depletion, or volume depletion.
This complication is especially common in diabetics and may cause hydronephrosis
Early (1-12 weeks)
Acute rejection
Antibodies against donor<unk>  develop after transplant
Dense interstitial lymphocytic infiltrate
Prevent/reverse with immunosuppressants
Immunosuppressive Cytotoxicity
Usually caused by calcineurin inhibitor toxicity
Reverse by decrease dosage of immunosuppressants
Infection
Most commonly polyoma (BK virus) or cytomegalovirus (CMV)
Polyoma virus is treated with intravenous immunoglobulins
CMV is treated with antivirals medications
Recurrence of primary disease
Antibodies against donor<unk>  develop after transplant
Dense interstitial lymphocytic infiltrate
Prevent/reverse with immunosuppressants
Usually caused by calcineurin inhibitor toxicity
Reverse by decrease dosage of immunosuppressants
Most commonly polyoma (BK virus) or cytomegalovirus (CMV)
Polyoma virus is treated with intravenous immunoglobulins
CMV is treated with antivirals medications
Late Acute (greater than 3 months)
Hypertension
Hypertension is common in ESRD/CKD patients and often worsens after transplant
Can result in decreased allograft survival
Renal artery stenosis
Important to identify because is a correctible cause of post-transplant hypertension
Acute Rejection
Same as above
Immunosuppressive cytotoxicity
Same as above
Hypertension is common in ESRD/CKD patients and often worsens after transplant
Can result in decreased allograft survival
Important to identify because is a correctible cause of post-transplant hypertension
Same as above
Same as above
Late Chronic (years later)
Chronic allograft nephropathy
Irreversible T-cell and antibody mediated damage
Causes vascular fibrosis
Immunosuppressive cytotoxicity
Same as above
Irreversible T-cell and antibody mediated damage
Causes vascular fibrosis
Same as above
Balance between immune suppression, rejection and susceptibility to infection
Typical regimen includes: calcineurin inhibitor + antimetabolite + steroid
Calcineurin inhibitor
Cyclosporine
Tacrolimus
Steroids
Prednisone/Prednisolone
+/- Antimetabolite
Azathioprine
Mycophenolate mofetil (MMF)
Calcineurin inhibitor
Cyclosporine
Tacrolimus
Steroids
Prednisone/Prednisolone
+/- Antimetabolite
Azathioprine
Mycophenolate mofetil (MMF)
Cyclosporine
Tacrolimus
Prednisone/Prednisolone
Azathioprine
Mycophenolate mofetil (MMF)
Kidney transplant complications
Solid organ rejection
Liver transplant complications
Infection
Pancreas transplant complications
Medication side effect
Ureteral stent complications
Graft-versus-host disease