Kidney Week

Abstract: SA-PO1198

Segmental Kidney Allograft Infarction with Preserved Graft Function at Nine-Month Follow-Up

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

• Piña Vicente, Brandon, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Brandon Piña Vicente, MD

• Banda Lopez, Adriana, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Adriana Banda Lopez, MD

• Cruz Landino, Moises, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Moises Cruz Landino, MD

• Mendoza Cabrera, Salvador, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Salvador Mendoza Cabrera, MD

• Garcia Vallejo, Diana Vianney, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Diana Vianney Garcia Vallejo, MD

• González Maldonado, Marilyn, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Marilyn González Maldonado, MD

Introduction

Renal allograft infarction is an uncommon vascular complication associated with early graft dysfunction and graft loss. Reports of segmental infarction with preserved graft function are scarce.

Case Description

A 31-year-old woman with ESKD on hemodialysis for 12 years underwent deceased-donor kidney transplantation from a 56-year-old female donor who died from subarachnoid hemorrhage. A left kidney graft with two arteries, one vein, and one ureter was implanted using end-to-side vascular anastomoses. Cold ischemia time was 2 h 29 min. Crossmatch testing was negative, and thymoglobulin induction therapy was administered without intraoperative complications. In the immediate postoperative period, the patient developed delayed graft function with serum creatinine of 6.1 mg/dL and urine output of 0.6 mL/kg/h, requiring four hemodialysis sessions. Doppler ultrasound demonstrated absent flow in the lower pole of the graft. Contrast-enhanced CT confirmed thrombosis of segmental arteries involving the interpolar and lower pole regions, affecting 50% of the graft parenchyma.
Urgent surgical re-exploration demonstrated preserved patency of the main renal artery and vein without compromise of the vascular anastomosis. However, the inferior polar artery lacked pulsatility, with ischemic discoloration of the posteroinferior region. Mechanical thrombectomy with reconstruction of the arterial anastomosis was successfully performed.

Discussion

The patient subsequently showed recovery of graft function and was discharged on postoperative day 16 with serum creatinine of 0.9 mg/dL. At 9-month follow-up, she maintains preserved renal allograft function under therapy with tacrolimus, MMF, prednisone, and finerenone.
This case highlights that segmental renal allograft infarction may be successfully salvaged with prompt diagnosis and surgical intervention. The functional impact appears to depend on the vascular territory involved, underscoring the importance of close clinical and imaging surveillance in post-transplant vascular complications.