Abstract: SA-PO1200
Selective Transplant Renal Artery Embolization as a Nephrectomy-Sparing Treatment for Failed Kidney Allograft Intolerance Syndrome: A Case Report with Two-Year 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
- Alamri, Nada, Madinah Health Cluster, Medina, Saudi Arabia
- Dhahi, Turki Mohammed, Royal Commission Medical Center, Yanbu, Al Madinah Province, Saudi Arabia
- Abdelsalam, Abdelsalam A Abdelaziz, King Fahad Hospital, Madina, Saudi Arabia
- Halawani, Rayan Talal, Madinah Health Cluster, Medina, Saudi Arabia
- Ashour, Albaraa O., Madinah Health Cluster, Medina, Saudi Arabia
- Al-Arabi, Tammam Mahmoud, King Salman bin Abdulaziz Medical City, Medina, Al Madinah Province, Saudi Arabia
Introduction
Failed renal allograft intolerance syndrome is inflammation of a nonfunctioning kidney transplant Left in situ. It may cause graft pain, hematuria, graft enlargement, fever, and elevated inflammatory markers. Nephrectomy is standard for refractory symptoms; embolization is less invasive.
Case Description
A 62-yearold man with a failed renal allograft presented with recurrent graft-site pain and intermittent gross hematuria for one year. He had a living-related kidney transplant in 2014 for ESKD of undertermin etiology. The graft failed 14 months earlier from chronic antibody-mediated rejection, and he returned to hemodialysis. He remained on tacrolimus 0.5 mg twice daily and prednisone 5 mg daily. Hematuria improved after prednisone escalation but recurred with graft pain. He had no fever, dysuria, clot retention, weight loss, night sweats, UTI, anticoagulant use, trauma or malignancy. Examination showed right graft tenderness without palpable lymphadenopathy or volume overload. Urinalysis showed RBCs >100/high-power field. Three urine cultures and blood cultures were negative. CRP decreased from 100 to 30 mg/L after prednisone escalation. EBV PCR was negative. Cystoscopy showed no urethral or bladder lesion. CT showed an enlarged allograft with regional lymphadenopathy, favored reactive, without collection or mass. A team selected transplant renal artery embolization before nephrectomy. Through left femoral access, the transplant renal artery from the right external iliac artery was catheterized and embolized with 4 x 7 mm and 3 x 3 mm pushable coils. Completion angiography confirmed occlusion without complications. The early course was uneventful, with no post-embolization syndrome, infection, access-site complication, transfusion, readmission, or steroid escalation. At 1 year, he was pain-free with no recurrent hematuria or graft-intolerance symptoms. CT at 2 years showed reduced allograft size and smaller non significant lymph nodes. Nephrectomy was avoided.
Discussion
This case supports transplant renal artery embolization as a nephrectomy sparing option for failed allograft intolerance syndrome after excluding infection, malignancy, and lower urinary tract lesion. Durable symptom resolution, absence of complications, and radiologic regression suggest control of the inflammatory graft process.