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C. Delayed Graft Function

Delayed graft function immediately posttransplantation is usually due to acute tubular necrosis (ATN). It commonly occurs in cadaver allografts and rarely in kidneys from living donors. Delayed graft function in a living donor transplant should provoke work-up for causes other than ATN. The clinical significance of delayed graft function on allograft functional survival is significant. The frequency of delayed graft function is variable among the different transplant centers and approximates roughly 20-40% of cadaver transplants. Risk of delayed graft function in cadaveric kidneys includes prolonged cold ischemia time, the age and medical condition of the cadaveric organ donor, and excessive early use of calcineurin inhibitors. ATN is usually limited to approximately 2-6 days. It can be prolonged for up to several weeks. If persistent, a simultaneous acute rejection episode may occur, as well as acute nephrotoxicity of the calcineurin inhibitors. Successful care of the patient with delayed graft function requires good judgment on the timing of renal allograft biopsy.

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