 Introduction/Background Renal transplantation is the preferred treatment method in patients with end-stage renal failure. Compared with maintenance dialysis, most patients who receive a successful transplant experience an improved quality of life and a significant reduction in mortality [1]. According to the Organ Procurement and Transplantation Network of the U.S. Health Resources and Services Administration, over 375,000 renal transplants have been performed in the United States since 1988 [2]. In 2014 alone, 17,108 renal transplants were performed, of which 11,570 were from deceased donors and 5538 were from living donors. Unfortunately, there remains a huge imbalance between organ availability and demand. Although the number of candidates on the waiting list has increased, the total number of renal transplants performed in the United States has not increased significantly in the last decade. When a renal transplant is performed, every effort is made to address allograft dysfunction by management of immunosuppression and transplant complications. Five-year survival rates for the graft in renal transplant patients range from 72% to 99%, with the best rates seen in patients receiving kidneys from living donors. Although the timing of intrinsic renal dysfunction may aid in narrowing the differential diagnosis, there is significant overlap between the various etiologies. In the immediate postoperative period (<1 week), the most common etiology of intrinsic dysfunction is acute tubular necrosis (ATN). ATN is seen in the immediate post- transplant period in a high percentage of cadaver grafts but occurs infrequently in living related donors. Acute rejection occurs from 1 week to 1 month after transplantation. Fortunately, acute rejection is an uncommon occurrence in current practice [3].
Renal Transplant Dysfunction.  Introduction/Background Renal transplantation is the preferred treatment method in patients with end-stage renal failure. Compared with maintenance dialysis, most patients who receive a successful transplant experience an improved quality of life and a significant reduction in mortality [1]. According to the Organ Procurement and Transplantation Network of the U.S. Health Resources and Services Administration, over 375,000 renal transplants have been performed in the United States since 1988 [2]. In 2014 alone, 17,108 renal transplants were performed, of which 11,570 were from deceased donors and 5538 were from living donors. Unfortunately, there remains a huge imbalance between organ availability and demand. Although the number of candidates on the waiting list has increased, the total number of renal transplants performed in the United States has not increased significantly in the last decade. When a renal transplant is performed, every effort is made to address allograft dysfunction by management of immunosuppression and transplant complications. Five-year survival rates for the graft in renal transplant patients range from 72% to 99%, with the best rates seen in patients receiving kidneys from living donors. Although the timing of intrinsic renal dysfunction may aid in narrowing the differential diagnosis, there is significant overlap between the various etiologies. In the immediate postoperative period (<1 week), the most common etiology of intrinsic dysfunction is acute tubular necrosis (ATN). ATN is seen in the immediate post- transplant period in a high percentage of cadaver grafts but occurs infrequently in living related donors. Acute rejection occurs from 1 week to 1 month after transplantation. Fortunately, acute rejection is an uncommon occurrence in current practice [3].