In renal transplantation, the most common cause of early graft dysfunction within the first week is:
- A Delayed graft function (DGF) due to ischaemia-reperfusion injury ✓
- B Hyperacute rejection mediated by pre-formed donor-specific antibodies
- C Acute cellular rejection mediated by T-lymphocytes
- D Calcineurin inhibitor nephrotoxicity
Correct answer: A. Delayed graft function (DGF) due to ischaemia-reperfusion injury
Explanation
Delayed graft function (DGF), defined as the need for dialysis within the first 7 days post-transplant, is the most common cause of early post-transplant graft dysfunction, occurring in up to 30–50% of deceased-donor transplants. It results from acute tubular necrosis (ATN) due to ischaemia-reperfusion injury sustained during cold ischaemia and warm ischaemia. Hyperacute rejection is now rare due to cross-matching. Acute cellular rejection typically presents after the first week. CNI nephrotoxicity is a concern but less common as the earliest primary cause.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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