Kidney Week

Abstract: SA-PO1182

Kidney Allograft Pseudoaneurysm After Procurement Biopsy: An Uncommon Driver of Post-Transplant Hypertension and Slow Graft Function

Session Information

• Transplantation: Clinical - Complications, Pediatrics, and Multi-Organ Considerations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Iftikhar, Nimra, The University of New Mexico Department of Internal Medicine, Albuquerque, New Mexico, United States

Nimra Iftikhar, MD

• Larson, Joshua J., The University of New Mexico Department of Internal Medicine, Albuquerque, New Mexico, United States

Joshua J. Larson, APRN, RN

• Singh, Pooja P., The University of New Mexico Department of Internal Medicine, Albuquerque, New Mexico, United States

Pooja P. Singh, MD, FASN

• Carrier, Kelsea, The University of New Mexico Department of Surgery, Albuquerque, New Mexico, United States

Kelsea Carrier, APRN, FNP

• Davis, Michael, The University of New Mexico Department of Surgery, Albuquerque, New Mexico, United States

Michael Davis, MD, MBA

• Singh, Namita, The University of New Mexico Department of Internal Medicine, Albuquerque, New Mexico, United States

Namita Singh, MD, MBBS, FASN

Introduction

Slow graft function (SGF) post-kidney transplant is most commonly attributed to acute tubular injury. A rare and under-recognized cause is pseudoaneurysm formation from procurement biopsies (incidence 0.2–2%). We report a case of SGF with persistent hypertension caused by a procurement biopsy–related pseudoaneurysm, successfully treated with selective angioembolization.

Case Description

A 41-year-old male with end-stage renal disease secondary to diabetes mellitus, underwent kidney transplantation in December 2025. Donor factors included donation after circulatory death, cold ischemia time of 69 minutes, warm ischemia time of 78 minutes, and pre-procurement biopsy showing no significant pathology. The allograft demonstrated immediate reperfusion with robust urine output post operatively, and doppler ultrasound (USG) performed in the recovery room showed a normal renal allograft with patent transplant vasculature. Serum creatinine (SCr) improved from 6.58 mg/dL pre-op to 3.64 mg/dL on post - operative day 3 (POD 3), then remained at 3 mg/dL on POD 4–5. Systolic BP remained 180–200 mmHg despite escalation of anti-hypertensive therapy during this time frame. Repeat doppler USG on POD 5 revealed a 2.9 cm superior pole pseudoaneurysm at the procurement biopsy site with classic yin-yang bidirectional flow and elevated resistive indices (0.67–0.90). Selective angioembolization with percutaneous thrombin injection was performed on POD 8, and SCr improved to mid-1 range, with normalization of systolic BP to ~110 mmHg.

Discussion

Post-transplant pseudoaneurysms are more commonly associated with anastomotic disruption, with procurement biopsies representing a less frequent cause of pseudoaneurysm. In cases of slow graft function accompanied by unexplained persistent hypertension after kidney transplantation, clinicians should maintain a high index of suspicion for a biopsy-related pseudoaneurysm if a procurement biopsy was done. Early evaluation with doppler imaging, followed by selective angioembolization, is essential to preserve renal parenchyma, restore allograft function, and normalize blood pressure.