Discussion Complications following renal transplants can be broadly divided into early and late categories. Although these categories overlap, this division can be useful in helping with the differential diagnosis when complications occur post-operatively. Early complications usually occur within 1-2 weeks and can include acute preservational injury, operative complications, and hyperacute or acute rejection. Early Complications Acute preservational injury is a type of acute tubular necrosis and is a common occurrence. Scintigraphically, acute preservational injury shows normal or slightly decreased perfusion but significant parenchymal dysfunction.
Hyperacute rejection occurs immediately post-operatively and is secondary to preformed antibodies.
This type of rejection is irreversible but is rare in the modern era due to close allogenic matching between donor and host. Acute rejection is much more common and usually occurs 5 days to years following transplant. Scintigraphy usually shows reduced perfusion while function is relatively maintained. Biopsy may be required for diagnosis. Acute rejection often responds to anti-rejection therapy.