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^-hyperacute rejection

"prolonged hypotension can precipitate the development of ATN

Lymphoceles typically manifest weeks or months posttransplant, and are easily detected by ultrasonography. These collections may be drained percutaneously or surgically into the abdominal cavity. Anastomotic ureteral obstruction is often treated by nephrostomy tube placement, followed by balloon dilatation and stenting. Surgical revision is often required. Functional obstruction from bladder distension may also be observed in male patients with prostatic hypertrophy, or in diabetics with neurogenic bladders.

Posttransplant oliguria or anuria caused by ischemic acute tubular necrosis (ATN) occurs commonly after cadaveric renal transplantation, with incidence reported from 10 to 50%. ATN following live donor transplantation is very uncommon, likely related to the minimal warm ischemic time, short preservation time, and excellent health status of the donor. ATN has been associated with highly sensitized recipients, prolonged (> 24hrs) cold ischemia time, cadaver donor age > 50 years, perioperative hypotension, and high dosing of calcineurin inhibitors. The management of posttransplant delayed graft function consists of general supportive measures, intermittent dialysis, avoidance of nephrotoxic medications, and continued close observation. The duration of ATN is typically 1-3 weeks, but can last as long as 3 months. Intermittent noninvasive imaging of these allografts should be considered to ensure adequate blood supply and rule out urine leak or obstruction. Allograft biopsy should be performed in cases of prolonged ATN (i.e., more than 2-3 weeks) to rule out the development of rejection. Recovery from ATN is associated with steady increase in daily urine volumes and a reduction is serum creatinine rise between dialysis treatments. Most patients experiencing ATN go on to acquire an adequate GFR.

Thromboembolic Disease

The risk of thromboembolic disease is increased following renal transplantation. Associated risk factors include older recipient age, postoperative immobilization, use of high dose steroids, treatment with calcineurin inhibitors such as cyclosporine, and increased blood viscosity from posttransplant erythrocytosis. All patients undergoing renal transplantation require some form of deep vein thrombosis prophylaxis, such as sequential leg compression devices. Diagnosis and management of venous thrombosis with appropriate tests and anticoagulation is no different than in other clinical situations.

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