Abstract
Introduction: Spontaneous renal allograft rupture (RAR) is a rare but serious complication post renal transplantation. Early diagnosis and management is of paramount importance in achieving both graft and recipients' survival.
Materials AND METHODS: We present a case of renal allograft rupture post living related kidney transplantation in 42-year-old lady with end stage renal disease on hemodiaylsis.
Results: On day 1 postoperatively urine output started to decrease to 900 cc for the first 24 hours. Doppler ultrasound examination was done and revealed normal blood flow to the graft and renal scan showed signs of acute tubular necrosis (ATN). On postoperative day 4, the patient developed sudden pain over the graft with a drop in haematocrit and in blood pressure accompanied with anuria. Intravenous fluid resuscitation was started and bed side ultrasound examination showed large perinephric hematoma extending onto the retroperitoneum for 20 cm above the upper pole of the graft. Patient was taken immediately to the operating room. At emergency exploration, a large crack was found on the lateral side of the graft extending for 10-12 cm length from the upper pole to the lower pole with active bleeding. Graft vessels were patent with no bleeding from anastomosis site. Bleeding was controlled using argon beam coagulator. Also, tachosil (R) patch was inserted in the crack and Bioglue (R) surgical adhesive was injected over it with application of pressure by wet gauze for 10-15 minutes. The bleeding stopped and biopsy was taken from the upper pole of the graft. Biopsy showed antibody-mediated rejection. Kidney functions improved with normal serum creatinine and urine output around 1.5 l/day.
Conclusion: graft nephrectomy is not mandatory in renal allograft rupture; it is sometimes salvageable with good perioperative care and adequate surgical technique.