24th June 2023

Complications of transplantation

Surgical/postoperative complications

• Bleeding
• Infection
• Urinary leak/obstruction
• Thrombosis of renal artery or vein
• Lymphocele
• Renal artery stenosis
• Bladder dysfunction (capacity reduces if a patient was anuric)

Issues with graft

• Delayed graft function – this is the requirement for dialysis post-transplantation. Risk factors include DCD donors, prolonged cold ischaemic time and donor acute kidney injury.
• Acute rejection – commonly T-cell mediated, can be antibody-mediated or a combination of the processes. A transplant biopsy is often performed for confirmation, and findings are classified using the Banff classification. Treatment depends on the findings but often utilises high dose intravenous steroids and optimisation of immunosuppressive drugs.
• Chronic graft dysfunction – multiple potential causes (immune and non-immune), including chronic antibody-mediated or T-cell-mediated rejection, calcineurin-inhibitor toxicity, recipient factors such as hypertension and donor factors such as DCD kidney or older age.
• Disease recurrence, e.g. focal segmental glomerulosclerosis
• Viral infection, e.g. BK nephropathy

Other medical problems

• Infection – transplant recipients are prone to a multitude of infections, however, it is important to give prophylaxis for/have high clinical suspicion for PCP and CMV. High risk patients should be considered for tuberculosis prophylaxis.
• Malignancy – notably skin (benign and malignant lesions) and post-transplant lymphoproliferative disorder (EBV is a risk factor).
• Cardiovascular disease
• Diabetes – risk associated with immunosuppressive drugs such as tacrolimus and steroids.