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Krishna A, Maqbool U, Bansal VK, Prakash O, Kumar S. Spontaneous renal allograft rupture of unknown etiology - A case report. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_69_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Favi E, Iesari S, Cina A, Citterio F. Spontaneous renal allograft rupture complicated by urinary leakage: case report and review of the literature. BMC Urol 2015; 15:114. [PMID: 26581472 PMCID: PMC4650853 DOI: 10.1186/s12894-015-0109-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 11/03/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND For more than forty years, graftectomy has been the standard treatment of spontaneous renal transplant rupture. However, recent evidences suggest that graft salvage strategies can be safely pursued, even in difficult cases. CASE PRESENTATION We report on a thirty-nine-year-old woman who received a deceased donor kidney transplant and experienced spontaneous allograft rupture due to acute rejection. The rupture was further complicated by urinary leakage. The kidney and the ureter were successfully repaired. Eight years after transplantation, graft function is still excellent. CONCLUSION Due to the lack of transplantable organs and the long time usually spent on the waiting list, graftectomy should be only considered in case of refractory haemodynamic instability or compromised graft viability.
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Affiliation(s)
- Evaldo Favi
- Transplant Unit, Renal Department, Royal London Hospital, Whitechapel Road, London, E1 1BB, UK.
| | - Samuele Iesari
- General Surgery, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Pompeo Spennati, 67100, L'Aquila, Italy.
| | - Alessandro Cina
- Department of Bioimaging, Università Cattolica del "Sacro Cuore", Policlinico Universitario "Agostino Gemelli", Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Franco Citterio
- Renal Transplant Unit, Department of Surgery, Università Cattolica del "Sacro Cuore", Policlinico Universitario "Agostino Gemelli", Largo Agostino Gemelli 8, 00168, Rome, Italy.
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Rupture of renal transplant. Case Rep Transplant 2015; 2015:686584. [PMID: 25685589 PMCID: PMC4320787 DOI: 10.1155/2015/686584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/30/2014] [Accepted: 12/31/2014] [Indexed: 11/24/2022] Open
Abstract
Background. Rupture of renal allograft is a rare and serious complication of transplantation that is usually attributed to acute rejection, acute tubular necrosis, or renal vein thrombosis. Case Presentation. LD, a 26-year-old male with established renal failure, underwent deceased donor transplantation using kidney from a 50-year-old donor with acute kidney injury (Cr 430 mmol/L). LD had a stormy posttransplant recovery and required exploration immediately for significant bleeding. On day three after transplant, he developed pain/graft swelling and another significant haemorrhage with cardiovascular compromise which did not respond to aggressive resuscitation. At reexploration, the renal allograft was found to have a longitudinal rupture and was removed. Histology showed features of type IIa Banff 97 acute vascular rejection, moderate arteriosclerosis, and acute tubular necrosis. Conclusion. Possible ways of avoiding allograft rupture include use of well-matched, good quality kidneys; reducing or managing risk factors that would predispose to delayed graft function; ensuring a technically satisfactory transplant procedure with short cold and warm ischemia times; and avoiding large donor-recipient age gradients.
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Spontaneous renal allograft rupture due to iliac vein thrombophlebitis. INDIAN JOURNAL OF TRANSPLANTATION 2015. [DOI: 10.1016/j.ijt.2015.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Almarastani M, Aloudah N, Hamshow M, Hegab B, Alsaad KO. Salvaging of severely ruptured living-related renal allograft secondary to acute antibody mediated rejection. Int J Surg Case Rep 2014; 5:723-6. [PMID: 25216193 PMCID: PMC4189071 DOI: 10.1016/j.ijscr.2014.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 07/14/2014] [Accepted: 08/10/2014] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Spontaneous renal allograft rupture (RAR) is a serious and potentially life-threatening complication of kidney transplantation. Debate on the management of RAR has focused on graft nephrectomy versus salvaging in cases where: the allograft rupture site is surgically manageable; the bleeding can be controlled; and/or leaving the renal allograft in situ does not compromise patient survival. PRESENTATION OF CASE A 45-year-old, living-related, female, kidney allograft recipient experienced RAR on the fourth day post transplantation. Surgical exploration showed 12 cm laceration along the convex border of the graft. Histologically the graft demonstrated mild acute kidney injury and linear deposition of C4d along the cortical peritubular capillaries; morphological features for violent humoral or cellular rejection were not identified. The graft was surgically salvaged with excellent clinical and biochemical improvement. DISCUSSION Observations arising from this case are: (1) RAR caused by rejection is still encountered in clinical practice despite effective immunosuppressive management; (2) the severity of the histopathological features of rejection does not necessarily correlate with the extent of graft rupture; and (3) salvaging the graft should be attempted whenever possible as current immunosuppression and advances in surgical techniques may have an impact on long-term graft function and survival, differing from those previously published. CONCLUSION With modern immunosuppression therapy and proven surgical procedures, the efficacy of salvaged renal grafts and graft survival rates may improve substantially.
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Affiliation(s)
- Mohamad Almarastani
- Department of Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Noura Aloudah
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammad Hamshow
- Department of Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Bassem Hegab
- Department of Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Khaled O Alsaad
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
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Ferrannini M, Vischini G, De Angelis G, Giannakakis K, Arcese W. Spontaneous bilateral kidney rupture during autologous stem cell transplantation in a patient affected by amyloidosis. NDT Plus 2011; 4:56-9. [PMID: 25984105 PMCID: PMC4421635 DOI: 10.1093/ndtplus/sfq168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Revised: 07/28/2010] [Accepted: 09/06/2010] [Indexed: 11/28/2022] Open
Abstract
Kidney spontaneous rupture is not a recognized complication neither for amyloidosis nor of autologous stem cell transplantation (ASCT). A 46-year-old white woman, affected by nephrotic syndrome, was diagnosed as AL amyloidosis by renal biopsy. We report the singular case of a bilateral spontaneous kidney rupture during ASCT for AL with renal rescue.
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Affiliation(s)
| | - Gisella Vischini
- Nephrology and Dialysis Unit - S. Eugenio Hospital , Rome , Italy
| | | | | | - William Arcese
- Stem Cell Transplant Unit - 'Tor Vergata' University , Rome , Italy
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Late Renal Allograft Rupture Associated with Cessation of Immunosuppression following Graft Failure. Case Rep Transplant 2011. [PMID: 23198260 PMCID: PMC3505949 DOI: 10.1155/2011/512893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 29-year-old man developed chronic allograft nephropathy 63 months after renal transplantation. He became symptomatic with advanced chronic graft failure; his immunosuppressive medications were reduced and he was commenced on haemodialysis. Two months following the withdrawal of immunosuppression, he presented with abdominal pain, haematuria, and a marked drop in haemoglobin. The patient was taken to the operating room, where the renal allograft was found to be ruptured, and graft nephrectomy was subsequently performed. Histological examination of the graft specimen showed severe haemorrhagic acute vascular cellular rejection in a background of marked chronic allograft vasculopathy. Immunostaining for C4d showed diffuse, strong, linear circumferential staining of the peritubular capillaries, indicating a concurrent antibody-mediated rejection. We report herein an unusual case of spontaneous renal allograft rupture that occurred long time after transplantation due to severe acute rejection following cessation of immunosuppressive medications for advanced chronic allograft failure. To the best of our knowledge, the time interval between transplantation and the rupture of this allograft is the longest of those reported in the literature.
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8
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Abstract
A 5-year-old domestic shorthair cat, that had undergone renal transplantation 3 months earlier, was evaluated after an acute episode of abdominal discomfort. Abdominal ultrasound revealed an enlarged renal allograft (5.5 cm; reference range, 3.2–4.2 cm) with pyelectasia (renal pelvis=3.7 mm; reference range, 1–2 mm). Based on the ultrasonographic appearance of the allograft, primary rule-outs for the renomegaly included hypertrophy and allograft rejection. The ureter and urethra were dilated and a mild amount of abdominal effusion was noted. Thirty-six hours after admission, the cat became acutely hemodynamically unstable and was diagnosed with a hemoabdomen. Review of the original ultrasound revealed a peri-renal hematoma. During emergency laparotomy, ruptures in the cortex of the transplanted kidney were found to be the source of hemorrhage. Immediately following surgery, the cat experienced cardiorespiratory arrest, and resuscitation was not successful. Necropsy and histopathology revealed rupture of the renal allograft. This is the first reported case of renal allograft rupture in a cat, whereas allograft rupture has been reported in human renal transplant patients.
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Basaran C, Donmez FY, Tarhan NC, Coskun M, Haberal M. Multidetector computed tomography findings of spontaneous renal allograft ruptures. Clin Radiol 2009; 64:523-8. [PMID: 19348849 DOI: 10.1016/j.crad.2009.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 12/27/2008] [Accepted: 01/06/2009] [Indexed: 10/21/2022]
Abstract
AIM To describe the characteristics of spontaneous renal allograft rupture using multidetector computed tomography (MDCT). METHOD Five patients with spontaneous renal allograft rupture, as confirmed by pathologic examination, were referred to our institution between 1985 and 2008. The clinical records and preoperative MDCT findings of the patients were studied retrospectively. RESULTS Clinical and/or histological findings were consistent with acute rejection in all cases. Using MDCT, disruption of the capsular integrity and parenchymal rupture was seen in four patients. Four of the five patients showed decreased enhancement and swollen grafts. Perirenal (n=4), subcapsular (n=1), and intraparenchymal (n=1) haematomas were also seen. In the patient with an intraparenchymal haematoma there was no disruption of capsular integrity, but capsular irregularities were seen near the haematoma. CONCLUSION MDCT is a useful investigative tool for the evaluation of suspected spontaneous renal allograft rupture. As well as a swollen graft, disruption of the capsule, parenchyma, and/or haematoma should prompt the radiologist to consider this diagnosis.
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Affiliation(s)
- C Basaran
- Department of Radiology, Baskent University Faculty of Medicine, Ankara, Turkey.
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Abstract
Spontaneous renal allograft rupture is one of the most dangerous complications of kidney transplantation, which can result in graft loss. This condition needs immediate surgical intervention. Conservative management has dismal results. Its prevalence varies from 0.3% to 3%. Rupture occurs in first few weeks after transplantation. Predisposing factors for graft rupture are acute rejection, acute tubular necrosis, and renal vein thrombosis. There are growing reports about successful results of repairing these ruptured kidneys. In this study, we reviewed the medical records of 1682 patients who received kidney allografts from living donors from 1986 through 2003. There were six (0.35%) cases of renal allograft rupture. All were preceded by acute graft rejection. They were treated with antirejection medications. In first three cases, the kidney allografts were removed because the procedure of choice in this situation is graft nephrectomy; but in three next cases we repaired the ruptured grafts with good results in two of them. In conclusion, the procedure of choice for kidney allograft rupture is graft repair.
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Affiliation(s)
- H Shahrokh
- Hasheminejad Medical Center, Tehran, Iran.
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Sanchez de la Nieta MDG, Sánchez-Fructuoso AI, Alcázar R, Pérez-Contin MJ, Prats D, Grimalt J, Blanco J. Higher graft salvage rate in renal allograft rupture associated with acute tubular necrosis. Transplant Proc 2005; 36:3016-8. [PMID: 15686684 DOI: 10.1016/j.transproceed.2004.10.080] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Renal allograft rupture is an early postoperative complication threatening graft and patient survival. We reviewed the etiology and prognostic factors for renal allograft rupture. MATERIAL AND METHODS Among 657 renal transplants performed between 1990 and 2001, renal allograft rupture was diagnosed in 10 cases. Statistical analysis by Student t test, ANOVA, and chi-square was performed to assess donor and recipient characteristics. Multivariate logistic regression to predict renal allograft rupture used variables with P <.15 in the univariate analysis. RESULTS Patients with renal allograft rupture were mainly men and young. Renal allograft rupture incidence was higher among allografts from non-heart-beating donors, kidneys with delayed graft function, or patients with a high antibody titer. Histopathological findings revealed that six renal allograft ruptures were secondary to acute rejection, three to acute tubular rejection and one to allograft infarction. Only one of six renal allograft ruptures (17.7%) secondary to rejection was resolved by surgery; two of the three patients (66.7%) with acute tubular necrosis were successfully operated and a nephrectomy was performed for the patient with allograft infarction. By multivariate logistic regression analysis, factors shown to be predictive for renal allograft rupture were: delayed graft function, age of recipient, peak panel-reactive antibody >25%, and initial immunosuppressive treatment without antithymocyte globulin. CONCLUSIONS Higher graft salvage rates are possible in cases of graft rupture associated with acute tubular necrosis.
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He B, Rao MM, Han X, Li X, Guan D, Gao J. Surgical repair of spontaneous renal allograft rupture: a new procedure. ANZ J Surg 2003; 73:381-3. [PMID: 12801330 DOI: 10.1046/j.1445-2197.2003.t01-1-02650.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of the present paper is to introduce a new surgical procedure using the external oblique aponeurosis (EOA) for repair of spontaneous renal allograft rupture. METHODS Thirty-eight cases with spontaneous renal allograft rupture were encountered in 1000 consecutive kidney transplants between April 1991 and August 2000. Thirty-three cases underwent surgical exploration with two grafts undergoing nephrectomy, while a further 31 were repaired using the new surgical procedure. The external oblique aponeurosis (EOA) from the incision was trimmed into 1 cm x 1 cm square pieces. A 2/0 Dexon suture was placed through each piece of the EOA, then through the parenchyma of the kidney perpendicular to the rupture. Each suture was then placed through another piece of EOA and tied. RESULTS Two repaired grafts were removed on day 7 and day 10, one due to graft re-rupture and another with ischaemia secondary to irreversible acute rejection. The graft function of 29 cases had recovered completely at 30 days following surgical repair with one graft improving rapidly. Thirteen grafts were diagnosed as undergoing mild to moderate acute rejection, whereas a further 20 cases were considered to have acute tubular necrosis on histopathology. The allograft survival rate at 1 year and 5 years post grafting was 86% and 64%, respectively. No patients died from postoperative complications following repair using this procedure. CONCLUSIONS Spontaneous renal allograft rupture is a relatively common post-transplant complication secondary to either acute tubular necrosis or acute rejection. This new surgical procedure is proposed as a reliable and practical method of repair following graft rupture. Preservation of graft function and viability following rupture appears achievable both in the medium and long-term.
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Affiliation(s)
- Bulang He
- Institute of Urology, Beijing Chaoyang Hospital, Beijing, China.
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Hochleitner BW, Kafka R, Spechtenhauser B, Bösmüller C, Steurer W, Königsrainer A, Margreiter R. Renal allograft rupture is associated with rejection or acute tubular necrosis, but not with renal vein thrombosis. Nephrol Dial Transplant 2001; 16:124-7. [PMID: 11209005 DOI: 10.1093/ndt/16.1.124] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Whereas rejection was reported to be the most common cause of renal allograft rupture (RAR) in the pre-cyclosporin era, renal vein thrombosis (RVT) is purported to be the main cause of RAR in patients taking cyclosporin. The extremely low incidence of RVT in our series (0.11%) prompted us to analyse our collective with regard to RAR. METHOD Between 1974 and 1999, 1811 renal transplants were performed. Patients with RAR, defined as a tear of the renal capsule and parenchyma, were identified and possible underlying factors studied. RESULTS RAR was diagnosed in nine male and five female recipients (0.8%) with a median age of 36 years. Immunosuppression consisted of azathioprine and prednisolone in seven patients and of cyclosporin-based therapy in the seven others. At exploration five grafts were removed immediately: three because of irreversible rejection, one because of deep wound infection, and one with a twisted renal vein. Six of the nine salvaged kidneys have been functioning after a mean observation time of 45 months. In the pre-cyclosporin era RAR was associated with acute rejection in five out of seven cases as compared with only three of the seven on cyclosporin treatment. Core biopsies might have been the cause in three cases. CONCLUSION RAR is a rare complication after renal transplantation. Acute rejection still represents the most frequent cause of RAR in the cyclosporin era.
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Affiliation(s)
- B W Hochleitner
- Department of Transplant Surgery, Innsbruck University Hospital, Innsbruck, Austria
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Ramos M, Martins L, Dias L, Henriques AC, Soares J, Queirós J, Sarmento AM. Renal allograft rupture: a clinicopathologic review. Transplant Proc 2000; 32:2597-8. [PMID: 11134721 DOI: 10.1016/s0041-1345(00)01801-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M Ramos
- Departments of Urology and Nefrology, Hospital Geral de Santo António, Oporto, Portugal
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