Cox’s Conference: Renal Allograft Dysfunction

Cox’s Conference is our weekly ambulatory case conference led by an expert discussant and resident case presenter. This week Dr. Biff Palmer discussed a case of renal allograft dysfunction in a patient from Parkland Renal Transplant clinic presented by Dr. Peter Ye.

During this case, we reviewed the differential diagnosis of renal allograft dysfunction.

<1 Week from allograft transplantation (immediate):

  1. Surgical/Mechanical Complications
    • urine leak
    • lymphocele
    • hematoma
    • vascular injury leading to thrombosis (arterial or venous)
  2.  Drug toxicity (calcineurin inhibitor)
  3. Antibody-mediated rejection (pre-formed donor-specific antibodies)
  4. ATN

1 week to 3 months from allograft transplantation (early):

  1. Drug toxicity (calcinuerin inhibitor)
    • dose-dependent acute arteriolopathy from vasoconstriction
    • thrombotic microangiopathy
    • chronic tubular-interstitial fibrosis
  2. Acute rejection (T-cell mediated and antibody-mediated)
  3. Obstructive uropathy (e.g. lymphocele, bladder outlet obstruction)

>3 months from allograft transplantation (late):

  1. De novo renal disease
  2. recurrent primary disease
  3. typical non-transplanted related causes of acute or chronic renal injury
  4. BK nephropathy
  5. CMV
  6. Renal artery stenosis
  7. Drug-toxicity (calcineurin inhibitor)