Femoral neuropathy--an unusual complication of renal transplantation

Lumbosacral plexopathy after dual kidney transplantation

A 58-year-old man underwent dual kidney transplantation. He was unable to move his right leg after surgery. This was caused by extensive lumbosacral plexopathy on the side of surgery. Lumbosacral plexopathy after kidney transplantation is uncommon, because the plexus has rich anastomotic blood supply, and ischemic injury is unlikely. However, isolated femoral neuropathy after renal transplantation has been reported, as the distal portion of this nerve is supplied by branches of internal iliac artery only and is more prone to ischemic injury during surgery. Dual-kidney transplantation involves a larger dissection, and the procedure takes 60 to 90 minutes longer than single-kidney transplantation. It involves more vascular reconstruction. This may predispose the lumbosacral plexus to ischemic injury. To the best of our knowledge, this is the first reported case of lumbosacral plexopathy after a dual kidney transplantation, and this may be seen more frequently because this procedure is becoming more common.

Femoral neuropathy in renal transplantation

Acute femoral neuropathy after renal transplantation is an uncommon and rarely recognized complication. Recovery of the nerve is usual. Although rare, five cases have come to our attention in the past twenty years. A detailed clinical and electrophysiological analysis with a six month follow-up is presented. A review of sixteen other reported cases is also provided. The possible pathophysiology including direct compression and nerve ischemia, is discussed. We believe that nerve ischemia, possibly caused by a steal phenomenon, occurs in all cases following the anastomosis of the graft renal artery to the internal iliac artery, with a superimposed component of compression in some cases. The severity of ischemia probably determines the degree of recovery.

Femoral mononeuropathy induced by the lithotomy position: a report of 5 cases with a review of literature

We report 5 young women who developed femoral mononeuropathy (FMN) after placement in the lithotomy position. Three had uncomplicated vaginal deliveries and 2 underwent exploratory laparoscopies. EMG was performed on 3 patients. The lesions were localized to the inguinal ligament and probably demyelinating, accounting for their excellent prognosis. On reviewing the literature, however, we believe that lithotomy position can cause FMN, not only by nerve compression at the inguinal ligament, but also by stretching of the nerve by excessive hip abduction and external rotation.