Causes of Early Kidney Allograft Nonfunction

  • Kevin D. McBryde
  • Bruce A. Kaiser
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)


Early allograft non-function can be divided into immediate posttransplant period (days 0–7) and early posttransplant period (weeks 1–12). Immediate non-function is most commonly related to delayed graft function and is usually seen in deceased donor kidneys with longer cold ischemic time. Also, during this first week, surgical complications are more common and can include both vascular thrombosis and urologic obstruction. After that first week, during the early period, there is a greater variety of etiologies for non-function that include acute rejection, recurrence of primary disease, drug toxicity, and urological leaks. Delayed graft function can extend beyond the first week, and in this scenario, an allograft biopsy should be done since acute rejection is hard to diagnose in this situation. During these early periods, kidney non-function is more commonly associated with delayed graft function because in the current era of more aggressive immunosuppression protocols, the incidence of acute rejection is low.


Acute rejection Allograft non-function Children Cold ischemia time Congenital urinary tract abnormalities Delayed graft function End-stage renal disease Hyperacute rejection Kidney transplantation Recurrent disease Vascular thrombosis Urinary obstruction 



Acute tubular necrosis


BK virus


Congenital anomalies of the kidneys and urinary tract




Calcineurin inhibitors


Delayed graft function


End-stage renal disease


Focal segmental glomerulosclerosis


Human leukocyte antigen


Hemolytic uremic syndrome


Polymerase chain reaction


Urinary tract infection


  1. Balaz P, Rokosny S, Wohlfahrtova M et al (2013) Identification of expanded-criteria donor kidney grafts at lower risk for delayed graft function. Transplantation 96:633–638CrossRefPubMedGoogle Scholar
  2. Butala NM, Reese PP, Doshi MD et al (2013) Is delayed graft function causally associated with long-term outcomes after kidney transplantation? Instrumental variable analysis 1. Transplantation 95:1008–1014CrossRefPubMedPubMedCentralGoogle Scholar
  3. Cochat P, Fargue S, Mestrallet G et al (2009) Disease recurrence in paediatric renal transplantation. Pediatr Nephrol 24:2097–2108CrossRefPubMedPubMedCentralGoogle Scholar
  4. Cosio FG, Cattran DC (2017) Recent advances in our understanding of recurrent primary glomerulonephritis after kidney transplantation. Kidney Int 91:304–314CrossRefPubMedGoogle Scholar
  5. Cravedi P, Codreanu I, Satta A et al (2005) Cyclosporine prolongs delayed graft function in kidney transplantation: are rabbit anti-human thymocyte globulins the answer? Nephron Clin Pract 101:c65–c71CrossRefPubMedGoogle Scholar
  6. Damman J, Bloks VW, Daha MR et al (2015) Hypoxia and complement-and –coagulation pathways in the deceased organ donor as the major target for intervention to improve renal allograft outcome. Transplantation 99:1293–1300CrossRefPubMedGoogle Scholar
  7. Debout A, Foucher Y, Trébern-Launay K et al (2015) Each additional hour of cold ischemia time significantly increases the risk of graft failure and mortality following renal transplantation. Kidney Int 87:343–349CrossRefPubMedGoogle Scholar
  8. Dharnidharka VR, Araya CE (2016) Complications of pediatric renal transplantation. In: Aver ED, Harmon WE, Niaudet P, Yoshikawa N, Emma F, Goldstein SL (eds) Pediatric nephrology, 7th edn. Springer, Berlin/Heidelburg, pp 2575–2579Google Scholar
  9. Dharnidharka VR, Agodoa LY, Abbott KC (2007) Effects of urinary tract infection on outcomes after renal transplantation in children. Clin J Am Soc Nephrol 2:100–106CrossRefPubMedGoogle Scholar
  10. Dharnidharka VR, Fiorina P, Harmon WE (2014) Kidney transplantation in children. N Engl J Med 371:549–558CrossRefPubMedGoogle Scholar
  11. Djamali A, Kaufman DB, Ellis TM et al (2014) Diagnosis and management of antibody-mediated rejection: current status and novel approaches. Am J Transplant 14:255–271CrossRefPubMedPubMedCentralGoogle Scholar
  12. Doshi MD, Garg N, Reese PP et al (2011) Recipient risk factors associated with delayed graft function: a paired kidney analysis. Transplantation 91:666–671CrossRefPubMedGoogle Scholar
  13. Esezobor CI, Nourse P, Gajjar P (2012) Urinary tract infection following kidney transplantation: frequency, risk factors and graft function. Pediatr Nephrol 27:651–657CrossRefPubMedGoogle Scholar
  14. Fine RN (2007) Recurrence of nephrotic syndrome/focal segmental glomerulosclerosis following renal transplantation in children. Pediatr Nephrol 22:496–502CrossRefPubMedGoogle Scholar
  15. Fishman JA (2013) Infections in kidney transplant recipients. In: Morris PJ, Knechtle SJ (eds) Transplantation: principles and practice, 7th edn. Saunders of Elsevier, Philadelphia, pp 494–497Google Scholar
  16. Gaber AO, First MR, Tesi RJ et al (1998) Results of the double-blind, randomized, multicenter, phase III clinical trial of thymoglobulin versus ATGAM in the treatment of acute graft rejection episodes after renal transplantation. Transplantation 66:29–37CrossRefPubMedGoogle Scholar
  17. Gill J, Dong J, Eng M et al (2014) Pulsatile perfusion reduces the risk of delayed graft function in deceased donor kidney transplants, irrespective of donor type or cold ischemic time. Transplantation 97:668–674PubMedGoogle Scholar
  18. Hanaway MJ, Woodle ES, Mulgaonkar S et al (2011) Alemtuzumab induction in renal transplantation. N Engl J Med 364:1909–1919CrossRefPubMedGoogle Scholar
  19. Hass M (2016) The revised (2013) Banff classification for antibody-mediated rejection of renal allographs: update, difficulties and future considerations. Am J Transplant 16:1352–1357CrossRefGoogle Scholar
  20. Kranz B, Vester U, Nadalin S et al (2006) Outcome after kidney transplantation in children with thrombotic risk factors. Pediatr Transplantation 10:788–793CrossRefGoogle Scholar
  21. Loirat C, Niaudet P (2003) The risk of recurrence of hemolytic uremic syndrome after renal transplantation in children. Pediatr Nephrol 18:1095–1101CrossRefPubMedGoogle Scholar
  22. Matas AJ, Smith JM, Skeans MA et al (2014) OPTN/SRTR 2012 annual data report: kidney. Am J Transplant 14(Suppl 1):11–44CrossRefPubMedGoogle Scholar
  23. McDonald RA, SmithJM SD et al (2003) Pretransplant peritoneal dialysis and graft thrombosis following pediatric kidney transplantation: a NAPRTCS report. Pediatr Transplant 7:204–208CrossRefPubMedGoogle Scholar
  24. McEnery PT, Stablein DM, Arbus G et al (1992) Renal transplantation in children: a report of the north American pediatric renal transplant cooperative study. N Engl J Med 326:1727–1732CrossRefPubMedGoogle Scholar
  25. Mejia JC, Basu A, Shapiro R (2013) Calcineurin Inhibitors. In: Morris PJ, Knechtle SJ (eds) Transplantation: principles and practice, 7th edn. Saunders of Elsevier, Philadelphia, p 233Google Scholar
  26. Moers C, Smits JM, Maathuis M-H J et al (2009) Machine perfusion or cold storage in deceased-donor kidney transplantation. N Engl J Med 360:7–19CrossRefPubMedGoogle Scholar
  27. Montgomery RA, Hardy MA, Jordan SC et al (2004) Consensus opinion from the antibody working group on the diagnosis, reporting and risk assessment for antibody- mediated rejection and desensitization protocols. Transplantation 78:181–185CrossRefPubMedGoogle Scholar
  28. Nguyen M-T JP, Fryml E, Sahakian SK et al (2014) Pretransplant recipient regulatory T cell suppressive function predicts delayed and slow graft function after kidney transplantation. Transplantation 98:745–753CrossRefPubMedGoogle Scholar
  29. Niemann CU, Feiner J, Swain S et al (2015) Therapeutic hypothermia in deceased organ donors and kidney-graft function. N Engl J Med 373:405–414CrossRefPubMedGoogle Scholar
  30. O’Callaghan JM, Knight SR, Morgan RD et al (2012) Preservation solutions for static cold storage of kidney allografts: a systematic review and meta-analysis. Am J Transplant 12:896–906CrossRefPubMedGoogle Scholar
  31. Opelz G, Döhler B (2008) Influence of time of rejection on long-term graft survival in renal transplantation. Transplantation 85:661–666CrossRefPubMedGoogle Scholar
  32. Patel MS, Zatarain J, De La Cruz S et al (2014) The impact of meeting donor management goals on the number of organs transplanted per expanded criteria donor: a prospected study from UNOS region 5 donor management goals workgroup. JAMA Surg 149:969–975CrossRefPubMedGoogle Scholar
  33. Saidi RF, Elias N, Kawai T et al (2007) Outcome of kidney transplantation using expanded criteria donors and donation after cardiac death kidneys: realities and costs. Am J Transplant 7:2769–2774CrossRefPubMedGoogle Scholar
  34. Salmela KT, von Willebrand EO, Kyllönen LEJ et al (1992) Acute vascular rejection in renal transplantation – diagnosis and outcome. Transplantation 54:858–862CrossRefPubMedGoogle Scholar
  35. Salvatierra O Jr, Millan M, Concepcion W (2006) Pediatric renal transplantation with considerations for successful outcomes. Semin Pediatr Surg 15:208–217CrossRefPubMedGoogle Scholar
  36. Schold JD, Srinivas TR, Braun WE et al (2011) The relative risk of overall graft loss and acute rejection among African Americans renal transplant recipients is attenuated with advancing age. Clin Transpl 25:721–730CrossRefGoogle Scholar
  37. Schnuelle P, Schmitt WH, Weiss C et al (2017) Effects of dopamine donor pretreatment on graft survival after kidney transplantation: a randomized trial. Clin J Am Soc Nephrol 12:493–501CrossRefPubMedPubMedCentralGoogle Scholar
  38. Senggutuvan P, Cameron JS, Hartley RB et al (1990) Recurrence of focal segmental glomerulosclerosis in transplanted kidneys: analysis of incidence and risk factors in 59 allografts. Pediatr Nephrol 4:21–28CrossRefPubMedGoogle Scholar
  39. Shinn C, Malhotra D, Chan L et al (1999) Time course of response to pulse methylprenisolone therapy in renal transplant recipients with acute allograft rejection. Am J Kidney Dis 34:304–307CrossRefPubMedGoogle Scholar
  40. Siedlecki A, Irish W, Brennan DC (2011) Delayed graft function in the kidney transplant. Am J Transplant 11:2279–2296CrossRefPubMedPubMedCentralGoogle Scholar
  41. Solez K, Axelsen RA, Benediktsson H et al (1993) International standardization of criteria for the histologic diagnosis of renal allograft rejection: the Banff working classification of kidney transplant pathology. Kidney Int 44:411–422CrossRefPubMedGoogle Scholar
  42. Vacher-Coponat H, McDonald S, Clayton P et al (2013) Inferior early posttransplant outcomes for recipients of right versus left deceased donor kidneys: an ANZDATA registry analysis. Am J Transplant 13:399–405CrossRefPubMedGoogle Scholar
  43. Weber S, Tönshoff B (2005) Recurrence of focal-segmental glomerulosclerosis in children after renal transplantation: clinical and genetic aspects. Transplantation 80:S128–S134CrossRefPubMedGoogle Scholar
  44. Weissenbacher A, Jara M, Ulmer H et al (2012) Recipient and donor body mass index as important risk factors for delayed kidney graft function. Transplantation 93:524–529CrossRefPubMedGoogle Scholar
  45. Wu K, Budde K, Schmidt D et al (2015) The relationship of the severity and category of acute rejection with intimal artery arteritis defined in Banff classification to clinical outcomes. Transplantation 99:e105–e114CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.(HNP3) Division of Extramural Research(NIDCR) National Institute of Dental and Craniofacial ResearchBethesdaUSA
  2. 2.Division of Solid Organ Transplantation, EmeritusAlfred I. duPont Hospital for ChildrenWilmingtonUSA

Section editors and affiliations

  • Bruce Kaiser
    • 1
  1. 1.Division of Solid Organ Transplantation, EmeritusAlfred I. duPont Hospital for ChildrenWilmingtonUSA

Personalised recommendations