Should a Living Donor Renal Graft be Removed Due To Prolonged Delayed Function? A Case Report

Area of Science:

• Nephrology
• Transplantation immunology
• Surgical outcomes

Background:

• Delayed graft function (DGF) is the early post-transplant failure of a transplanted kidney.
• DGF is more common in deceased donor transplants due to longer ischemia times.
• Most DGF cases resolve spontaneously within weeks.

Observation:

• A 52-year-old male recipient experienced anuria on postoperative day 1 after a living donor kidney transplant with one antigen mismatch.
• Standard investigations ruled out rejection and ischemia, but the cause of dysfunction remained unclear.
• The patient required hemodialysis and expectant management.

Findings:

• The patient's DGF resolved after 55 days, with the graft eventually achieving normal renal function.
• This represents an unusually prolonged duration of DGF in a living donor kidney transplant.
• Normal graft function was ultimately achieved despite the extended anuric period.

Implications:

• Extremely rare cases of DGF can persist for over a month, even after living donor kidney transplantation.
• Thoroughly ruling out other causes of renal dysfunction is crucial before diagnosing prolonged DGF.
• Expectant management may lead to full graft recovery in select cases of DGF, even with anuria and dialysis dependence.