[A CASE OF DELAYED GRAFT FUNCTION FOLLOWING LIVING-DONOR KIDNEY TRANSPLANTATION WITH RECOVERY AFTER 28 DAYS OF HEMODIALYSIS].

Delayed graft function (DGF) is a rare complication following living-donor kidney transplantation, most commonly caused by ischemic acute tubular necrosis (ATN). We report a case in a 51-year-old woman with diabetic nephropathy who underwent an ABO-compatible living-donor kidney transplant from her younger brother. Although the procedure was completed without major complications, the patient developed persistent oliguria postoperatively. Serial allograft biopsies on postoperative days 1, 3, and 13 consistently showed findings of ATN without evidence of acute rejection or calcineurin inhibitor toxicity. Imaging studies revealed no vascular abnormalities or urinary tract obstruction. Despite adequate fluid management and stable hemodynamics, urine output remained below 500 ml/day for 26 days, and dialysis was required. On postoperative day 27, urine output gradually increased, allowing for withdrawal from dialysis by day 29. The patient was discharged on postoperative day 44, and renal function remained stable with a serum creatinine of 1.0 mg/dl at 9 months post-transplant. Intraoperative review of the donor nephrectomy video revealed purplish discoloration of the graft surface, raising suspicion of transient ischemia potentially caused by venous congestion during renal mobilization. This case emphasizes the importance of gentle vascular handling during donor nephrectomy and vigilant postoperative monitoring. Even in cases of prolonged DGF, recovery may be achieved with continued supportive therapy and repeated biopsies to rule out rejection. This report highlights that timely diagnosis and conservative management can lead to successful graft recovery, even after extended periods of oliguria.