Korean J Transplant.  2023 Nov;37(Suppl 1):S35. 10.4285/ATW2023.F-6043.

Delayed graft function three months after a living donor kidney transplantation

• Silalahi E
• Marbun M
• Susalit E
• Miranda M
• Saraswati M

• KMID: 2551622
• DOI: http://doi.org/10.4285/ATW2023.F-6043

Abstract

Kidney transplantation (KT) has been proven to provide a longer life expectancy and a better quality of life. KT recipient may experience what is referred to as a delayed graft function (DGF) complication with a frequency of occurrence at 25% to 30% making it one of the most common forms of acute kidney injury (AKI). A 56-year-old woman (body mass index of 19 kg/m 2 ), she decided to undergo a second transplantation procedure with living donor at Cipto Mangunkusumo Hospital. The physical examination blood pressure was consistently below 100 mmHg. human leukocyte antigen (HLA)-crossmatch cell lysis was 10%. The patient tested positive for donor-specific antibody, cytomegalovirus was 2,250 IU/mL. Prior to the operation, the pa-tient underwent plasmapheresis, cryoprecipitate procedure, along with intravenous immunoglobulin. After the operation, blood pressure increased to higher than 120 mmHg. The initial diuresis was 2,130 mL, which later dropped to 800 mL and finally to 0.Creatinine serum level was 3.3 mg/dL. Doppler ultrasonography was any delayed function (acute tubular necrosis). Biopsy (fol-lowing the allograft anastomosis) to assess parenchyma kidney with antibody mediated changes, Banff score was C4d2. Therapy for the patient included Methylprednisolone 16 mg/day, mycophenolate-sodium 360 mg/twice day, valganciclovir 450 mg/day. The recipient also underwent regular hemodialysis procedures twice a week for 3 months, resulting in an improvement in diuresis to 1,000 mL/24 hours. The creatinine level 0.9 mg/dL, with negative cytomegalovirus, Doppler ultrasonography was normal and clinically stable. DGF remains the most common complication that occurs in KT. Implementing an appropriate High-Risk management protocol prior to operation may prevent AKI and reduce the risk of failure.