26th June 2023

A 40-year-old woman with end-stage renal failure on haemodialysis undergoes a kidney transplant from a DBD donor,

A 40-year-old woman with end-stage renal failure on haemodialysis undergoes a kidney transplant from a DBD donor, there are no immediate surgical complications, and she is discharged to the ward with a surgical drain in situ. Having previously been anuric, she begins to produce some urine postoperatively, and initial bloods show a drop in her serum creatinine.

However, her urine output suddenly stops after two days. She is euvolaemic and her catheter is flushing well. She is noted to have an increase in fluid output from her surgical drain. Her serum creatinine level rises, and testing of the drain fluid shows a drain creatinine higher than her blood level.

What is the most likely cause of her anuria?