Graft dysfunction after kidney transplantation occur due to different causes. Diagnosis of graft dysfunction is a key component in the management of kidney transplant recipients. The aim of this study was to identify the causes of graft dysfunction in the first 3 months after kidney transplant by kidney biopsy for better graft survival. A total number of 250 patients who underwent renal transplantation at the Erbil teaching center from January 2020 to December 2020 were considered for this study. 50 biopsies were performed due to renal graft dysfunction in the first 3 months post-transplant. Descriptive statistics were analyzed using IBM SPSS Statistics software version 22.0. The biopsy results showed that acute cellular rejection (ACR) was observed in 21 patients (42%), acute interstitial nephritis (AIN) was found in 16 patients (32%), acute tubular necrosis (ATN) was occurred in 9 patients (18%), calcineurin inhibitor toxicity (CNI) was observed in 2 patients (4%), acute humoral rejection (AHR) was found in 1 patient (2%) and thrombotic microangiopathy (TMA) was occurred in 1 patient (2%). As a conclusion, the most important causes of graft dysfunction were ACR, AIN and ATN, respectively. Also, glomerulonephritis, diabetes and hypertension are the most risk factor for ESRD. In addition, the results of this study showed that Anti-HLA cross match can be used as an indicator for predicting the result of transplantation.

Keywords: graft dysfunction, Kidney transplantation, acute cellular rejection, acute interstitial nephritis