Renal transplant related complications

The recipients of renal transplants are susceptible to a number of complications. Incidence of each is variable and partially subject to specific surgical transplantation techniques and management patterns 3

Pathology

Renal transplant complications

These can be broadly categorized as perirenal, renal parenchymal, renal collecting system, and/or renal vascular complications 1,2:

  • perioperative acute tubular necrosis
  • renal allograft compartment syndrome
  • renal transplant rejection
  • renal arterial stenosis in the transplant renal artery 3:
    • peak systolic velocity (PSV) >200 cm/s
    • 2:1 PSV ratio between stenotic and prestenotic artery
    • spectral broadening distally (i.e. turbulent flow)
    • +/- renal parenchymal tardus-parvus waveform
  • renal vein thrombosis
  • acute perioperative renal artery thrombosis
  • arteriovenous fistula
  • perinephric fluid collection: occurring roughly in the order below post surgery
  • renal artery pseudoaneurysm
  • urinary obstruction 3
    • although usually presents within first 6 months following transplant, may occurs years later
    • clinically presents with rising creatinine and absence of renal colic (renal allograft is denervated)
    • site of obstruction is typically near transplant ureter / native bladder anastomosis
    • causes of obstruction 3
      • transplant ureter stenosis (most commonly due to scarring, kinking, or secondary to anastomotic technique)
      • less commonly pelvic fibrosis, calculi, papillary necrosis, external compression
  • graft pyelonephritis 4
  • infections 6:
    • nosocomial and procedure related
      • occurring <1 month after transplantation
      • donor related infections: HSV, rabies, West Nile virus
      • recipient acquired infections: Aspergillus spp., Pseudomonas spp.
    • latent, prior and opportunistic
      • occurring 1-6 months after transplantation
      • depending if patient is on PCP and antiviral prophylaxis
      • with: BK virus, HCV, adenovirus, influenza, Cryptococcus neoformans, Mycobacterium tuberculosis
      • without: Pneumocystis jirovecii, Herpes family, HBV, Listeria, Nocardia, Toxoplasma spp. 
    • community-acquired
      • occurring >6 months after transplantation
      • urinary tract infection, late viral infections and others (e.g. Nocardia, Aspergillus)
  • donor-related malignancy
Extra-renal transplant complications

Treatment and prognosis

The 1-year survival rate of deceased renal allografts were over 93% in 2014 5.

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Article information

rID: 991
Synonyms or Alternate Spellings:
  • Renal transplant complications
  • Complications with renal transplants
  • Complications related to renal transplant
  • Complications related to renal transplantation

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Cases and figures

  • Case 1: post transplant AVN
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  • Case 2: lymphocoele
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  • Case 3: AVF
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  • Case 4: hematoma
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  • Case 5: transplant renal artery stenosis
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