Overview
Delayed graft function (DGF) in renal transplantation refers to impaired kidney function within the first week post-transplantation, often requiring dialysis support. It is associated with increased morbidity, mortality, and graft loss 1.Diagnosis
Elevated serum creatinine levels ≥0.3 mg/dL within the first week post-transplant 1.
Need for dialysis in the first week post-transplant 1.
Urine output <0.5 mL/kg/hr for ≥6 hours 1.
Biopsy may show acute tubular necrosis or other specific histological findings 1.Management
Initiate dialysis if indicated by clinical deterioration or laboratory findings 1.
Optimize immunosuppression, considering potential drug interactions (e.g., monitor cyclosporine levels if ticagrelor is used 1).
Supportive care including fluid management, electrolyte correction, and infection prophylaxis 1.Special Populations
Drug Interactions: Close monitoring of cyclosporine levels is crucial in patients on ticagrelor due to potential pharmacokinetic interactions 1.Key Recommendations
Monitor cyclosporine trough levels closely when ticagrelor is co-administered to avoid toxicity 1 (Evidence: Weak).
Consider cessation of ticagrelor if significant cyclosporine level elevation occurs to prevent nephrotoxicity 1 (Evidence: Weak).
Retain and recruit nephrology nurses to ensure optimal post-transplant care and monitoring 2 (Evidence: Expert opinion).References
1 van Sloten TT, de Klaver PAG, van den Wall Bake AWL. Co-administration of cyclosporine and ticagrelor may lead to a higher exposure to cyclosporine: a case report of a 49-year-old man. British journal of clinical pharmacology 2018. link
2 Ulrich B. The nursing shortage and potential solutions: an overview. Nephrology nursing journal : journal of the American Nephrology Nurses' Association 2003. link