Abstract: TH-PO566
A Unique Case of Oliguric Renal Failure in the Immediate Post-Transplant Period
Session Information
- Trainee Case Reports - II
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1802 Transplantation: Clinical
Authors
- Chernova, Irene, Yale New Haven Hospital , New Haven, Connecticut, United States
- Asch, William S., Yale School of Medicine, New Haven, Connecticut, United States
Introduction
Vascular complications are a well-recognized cause of renal allograft failure in the immediate post-op period. Renal allograft torsion is a rare cause of vascular compromise leading to graft injury that is associated with significant morbidity. We present a case illustrating the unique challenges of recognizing and treating this condition.
Case Description
69yo F with history of end-stage renal disease secondary to polycystic kidneys on hemodialysis presented for deceased donor kidney transplantation. She had excellent urine output (UOP) and a transplant ultrasound with normal flow dynamics in the immediate post-op period; however, on post-op day #1 there was a significant decline in UOP which did not improve with intravenous fluid administration. Ultrasound of the graft demonstrated “abnormal waveforms throughout the transplanted kidney with tardus parvus waveforms and reversed diastolic flow” concerning for either renal artery stenosis or main renal vein thrombosis. She was taken emergently to the operating room for exploration. It was revealed that the graft had rotated 180 degrees about the axis of the artery and vein with the lower pole pointing toward the right flank. It appeared that the inferior aspect of her native right polycystic kidney may have abutted the upper pole of the allograft causing it to rotate medially. Upon reversal of the rotation there was immediate restoration of normal color, turgor and palpable pulse to the renal parenchyma and Doppler ultrasound confirmed excellent venous and arterial flows; a nephropexy was performed prior to closure. The patient had excellent post-op UOP and creatinine began downtrending in the next week and had stabilized at 0.8mg/dL by 1 month post-transplant.
Discussion
Fewer than 20 cases of allograft torsion have been reported in the literature as a cause of graft failure; over 50% of these grafts were lost. Most cases (15/16 in one review) occurred in simultaneous pancreas kidney (SPK) transplant recipients (13/16) or pediatric recipients (2/16). We present a rare case of a non-SPK allograft recipient who experienced allograft torsion and the first reported implicating native polycystic kidneys as a risk factor.
While a rare complication, allograft torsion is associated with a high rate of graft loss and non-specific ultrasound findings; a high index of suspicion and surgical exploration are needed to salvage the organ.