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Spontaneous renal allograft rupture of unknown etiology - A case report

Authors :
Umar Maqbool
Asuri Krishna
V K Bansal
Om Prakash
Subodh Kumar
Source :
Indian Journal of Transplantation, Vol 16, Iss 4, Pp 435-437 (2022)
Publication Year :
2022
Publisher :
Wolters Kluwer Medknow Publications, 2022.

Abstract

Rupture of renal allograft is a rare but serious complication of transplantation. This is usually attributed to acute rejection, acute tubular necrosis, or renal vein thrombosis. Some other causes such as renal graft biopsy and lymphatic obstruction are also mentioned as possible causes. This usually occurs during the first 1–3 weeks following transplantation, but cases occurring as late as 72 months have been reported. A 23-year-old male with established chronic kidney disease stage 5, underwent live-related renal transplantation using a kidney from a 46-year-old donor (mother). The laparoscopic donor nephrectomy was uneventful. The patient had an uneventful intraoperative course with usual early postoperative recovery. The patient was having a good early postoperative course. On postoperative day (POD) 2, there was sudden decrease in urine output to 100 ml/h. Ultrasonography Doppler on the same day evening showed normal color flow in the renal artery and renal vein. At around 7 p.m., there was sudden increase in drain output with fresh blood as content (500 ml in 10 min) with tachycardia and hypotension. In view of increased drain output, the patient was taken to operating room and reexploration was done. At reexploration, the renal allograft was found to have two longitudinal ruptures of around 8 cm × 1 cm × 2 cm and 5 cm × 1 cm × 1 cm (length × width × depth) with active bleed. The initial attempt was made to achieve hemostasis and salvage the graft kidney, but due to uncontrolled bleed, explantation was performed. Histology showed features of acute tubular injury. However, there was no evidence of acute rejection, acute tubular necrosis, or vascular thrombosis. This case demonstrates that early diagnosis and prompt treatment of a life-threatening condition such as renal allograft rupture with explantation of the graft may be required in certain conditions as a life-saving procedure.

Details

Language :
English
ISSN :
22120017 and 22120025
Volume :
16
Issue :
4
Database :
Directory of Open Access Journals
Journal :
Indian Journal of Transplantation
Publication Type :
Academic Journal
Accession number :
edsdoj.8225bd7e22364d8581a2383ce243c9e5
Document Type :
article
Full Text :
https://doi.org/10.4103/ijot.ijot_69_18