Evaluation and Initial Management of Graft Dysfunction

The initial assessment of kidney allograft dysfunction follows similar principles to the evaluation of native acute kidney injury, but with special attention to a broader differential diagnosis. Depending upon the timing post-transplant, surgical issues, infectious etiologies, and immunologic causes of graft dysfunction may be more or less likely; these causes are above and beyond typical concerns regarding medication toxicity, hemodynamic factors, and other common causes of kidney dysfunction. The purpose of this chapter is to provide the reader with an understanding of the potential causes of kidney transplant dysfunction and offer a framework for assessment and management in a stepwise manner. Many of the specific causes of graft dysfunction are discussed in greater detail in accompanying chapters, and the reader is directed to these chapters when applicable.