In renal transplantation, the phenomenon of delayed graft function (DGF) requiring dialysis in the first week is primarily caused by which pathophysiological mechanism related to donor graft retrieval?

• A Acute T-cell mediated rejection of the allograft
• B Ischaemia-reperfusion injury causing tubular necrosis (ATN) from prolonged cold or warm ischaemia time ✓
• C Hyperacute antibody-mediated rejection from preformed anti-HLA antibodies
• D Calcineurin inhibitor nephrotoxicity from immediate tacrolimus initiation

Explanation

Delayed graft function (DGF) occurs in 20–30% of deceased donor renal transplants and is primarily caused by ischaemia-reperfusion injury leading to acute tubular necrosis (ATN). Prolonged warm ischaemia time (time from cardiac arrest to cold flush) and cold ischaemia time (time in cold perfusion to reperfusion) are the key risk factors. Hyperacute rejection occurs within minutes (preformed antibodies) and is rare with crossmatch testing. DGF must be distinguished from primary non-function and early rejection by serial renal function monitoring and biopsy when indicated. DGF is associated with worse long-term graft survival.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.