Oliguria two days after a kidney transplant
History
54-year-old man, 2 days after a deceased-donor (donation after circulatory death) kidney transplant to the right iliac fossa; cold ischaemic time 16 h. Urine output 15–20 mL/h, creatinine not falling, still needing dialysis. Doppler ultrasound: patent artery and vein, no hydronephrosis, no collection. Request: graft perfusion and function.
Step 1 · Baseline study on day 2
On the flow phase the graft curve rises promptly after the iliac artery. Cortical uptake then rises slowly and is still rising at 30 min, and little tracer reaches the bladder. What is the most likely explanation for the pattern?