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Abstract: FR-PO738

Transplant Renal Artery Embolization: An Alternative to Transplant Nephrectomy in Patients with Graft Intolerance Syndrome

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Chaudhri, Imran, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Pavlakis, Martha, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

A subset of patients with failing renal allografts can develop what is known as graft intolerance syndrome (GIS); characterized by fever, malaise, hematuria, and graft tenderness. Traditionally, this was treated by surgical removal of the allograft, but embolization of the transplant renal artery is a potential alternative. Here, we describe a case of GIS with rapid resolution using non-surgical management.

Case Description

A 61-year-old man with history of type 2 diabetes, hypertension, hyperlipidemia, and end stage kidney disease (ESKD) presented in August 2022 with acute onset right lower quadrant (RLQ) abdominal pain. He had a deceased donor kidney transplant in December 2018 and his post-transplant course had been complicated by multiple episodes of acute antibody- and cell-mediated rejection. During this time, his immunosuppression was adjusted multiple times and in June 2022, he was admitted for volume overload and hyperkalemia and was initiated on hemodialysis. On that discharge, he was instructed to continue on a prednisone taper and mycophenolate. Despite these instructions, the patient stopped taking his immunosuppression on his own and subsequently presented with abdominal pain in August 2022.
On exam, he was hypertensive to 190/76 and had tenderness to palpation over his allograft. Computerized tomography (CT) of his abdomen showed that his allograft kidney was enlarged at 14 cm by length. A diagnosis of GIS was made. A multidisciplinary discussion between transplant surgery, transplant nephrology, and interventional radiology (IR) occurred and in the end, percutaneous renal artery embolization was pursued by IR. His symptoms resolved, and he was discharged 2 days after the procedure.


Traditionally, when GIS is treated with transplant nephrectomy, reported complications include infection, bleeding, human leukocyte antigen sensitization, and death. Transplant renal artery embolization is less invasive, associated with shorter length of stay and, in some studies, with reduced mortality and morbidity. Our patient obtained almost immediate relief with a much less invasive approach and continues to be symptom free. In summary, this case illustrates that renal artery embolization of the allograft can be an effective and safe alternative to transplant nephrectomy in patients with GIS.