Altered Graft Function

An increase in creatinine may be caused by a number of processes, but common causes are:

• Rejection
• Infection, e.g. urine, CMV
• Tacrolimus / Ciclosporin toxicity
• Altered fluid balance

Less common causes are:

• Vascular catastrophe
• Mechanical problem - urinary obstruction (less likely if ureteric stent present), lymphocele

A patient whose creatinine has increased requires careful assessment, as the classic signs of rejection (pyrexia, tender graft) are rarely present with current immunosuppressive agents.

• Review patient's fluid status and fluid balance charts;
• Check FBC
• Note particular decrease in urine volumes, tender graft;
• Check for pyrexia;
• Culture urine, PD fluid;
• Consider CMV PCR and rapid culture.
• Get Tacro / CyA level
• Consider USS to exclude mechanical/vascular problem, with Duplex to confirm patency of major vessels

Transplant protocols developed on the Edinburgh Transplant Unit. This page first published in December 2006, last modified Tuesday, August 11, 2009.

NOTE that the accuracy of any statements in this information CANNOT be guaranteed. It is published in the belief that it is correct, and we endeavour to keep it so - but we do make mistakes. Furthermore, over some subjects there are differing opinions, or differing degrees of certainty. We have usually not attempted to discuss these here because the aim has been to provide an immediate and brief guide. In all areas, prior medical knowledge is assumed. The EdRenHANDBOOK is not suitable for use by those without such a background. Contact us by email or at the address given at the foot of the contents page with any comments or corrections.