Acute Tubular Necrosis in Renal Transplantation

Epidemiology and Presentation

The American College of Radiology notes that acute tubular necrosis (ATN) is the most common post-surgical complication in the immediate period following renal transplantation, occurring in approximately 67% of recipients of deceased donor kidneys and 9% of those with living donors 1, 2
ATN represents the most common cause of intrinsic graft dysfunction in the immediate postoperative period (first week) 1, 2
The period of presentation for ATN is typically within the first 7 days post-transplant 1, 2

The American College of Radiology recommends distinguishing ATN from other complications, including vascular complications such as renal artery thrombosis, characterized by complete absence of arterial flow on Doppler, and renal vein thrombosis, characterized by absence of venous flow with renal enlargement 1, 2

The American College of Radiology suggests that Doppler ultrasound is the first-line imaging modality for evaluating renal transplant dysfunction, with findings in ATN including a normal-sized kidney with preserved corticomedullary differentiation 2
Technetium-99m MAG3 renal scintigraphy may show a persistent nephrogram without excretion 3

The American College of Radiology notes that seromas and hematomas typically occur in the first week, while abscesses and urinomas occur 1-3 weeks post-transplant, and lymphoceles occur 1-2 months post-transplant, happening in 50% of patients 1