A New Proposal of Surgical Suture in Case of Spontaneous Renal Allograft Rupture Q. Laia,*, V. Rizzaa, L. Di Clementeb, S. Iesaria, M. Bellobonoa, Z. Bianchia, K. Clementea, A. Famularia, and F. Pisania a Transplant Unit, Department of Surgery, University of L’Aquila, San Salvatore Hospital, via L’Aquila, Italy; and bUrologic Unit, San Salvatore Hospital, via Vetoio, L’Aquila, Italy
ABSTRACT Introduction. Spontaneous kidney allograft rupture (KAR) is a rare but potentially lifethreatening complication after kidney transplantation. It is associated with a high risk of graft loss and patient death. We report a new technique of surgical repair in case of KAR. Case Report. A 53-year-old man transplanted due to diabetic nephropathy-related endstage renal disease experienced a spontaneous KAR 10 days after KT. Immediate laparotomy revealed the presence of a 4-cm linear kidney fracture. Dexon 2-0 wires were used for the suture, stopping each wire with Hem-o-Loks on a cylinder of oxidized cellulose gauze, with the intent of avoiding the risk of tissue fracture caused by the suture itself. Bleeding was thus controlled. The patient experienced an uneventful course and was discharged on postoperative day 26. Conclusions. According to the recent literature, graft nephrectomy for KAR is no longer considered the standard surgical treatment. A new approach to rupture repair has been proposed, providing good rates of graft and patient survival.
S
PONTANEOUS kidney allograft rupture (KAR) is a serious complication of kidney transplantation (KT) that potentially threatens graft and patient survival. The first early spontaneous renal graft ruptures were reported by Haberal et al [1]. According to the literature, the incidence of KAR is w0.8% to 6%. KAR is frequently associated with several conditions, the most common of which are acute rejection, acute tubular necrosis, vascular thromboses, hypertension, traumas, and infections [2]. Surgical treatment strategies consist of transplantectomy or surgical repair. Different parenchymal repair methods have been reported previously. We describe for the first time a new surgical approach to adopt in case of KAR.
sudden abdominal pain in the left iliac fossa associated with hypotension, oliguria, and anemia (hemoglobin, 7.8 g/dl). Ultrasounds detected perinephric fluid collection. An immediate laparotomy revealed the presence of a large extraperitoneal hematoma with a concomitant 4-cm linear kidney rupture (Fig 1A). KAR was sutured with an absorbable polyglycolic acid suture, stopping each stitch by Hem-o-Loks placed on a cylinder of oxidized cellulose gauze. After the suturing, bleeding was controlled. A TachoSil sponge (Baxter, Illinois, USA) was finally placed at the level of the suture (Fig 1B). The patient had an uneventful course and was discharged on postoperative day 26 with a blood urea nitrogen level of 58 mg/dl and a serum creatinine concentration of 1.3 mg/dl. Two years after KT, the patient is alive with normal renal function.
DISCUSSION CASE REPORT A 53-year-old man underwent a deceased-donor KT due to endstage renal disease caused by diabetic nephropathy. The donor was 44 years old. Panel reactive HLA for antibodies was
ABSTRACT Introduction. Spontaneous kidney allograft rupture (KAR) is a rare but potentially lifethreatening complication after kidney transplantation. It is associated with a high risk of graft loss and patient death. We report a new technique of surgical repair in case of KAR. Case Report. A 53-year-old man transplanted due to diabetic nephropathy-related endstage renal disease experienced a spontaneous KAR 10 days after KT. Immediate laparotomy revealed the presence of a 4-cm linear kidney fracture. Dexon 2-0 wires were used for the suture, stopping each wire with Hem-o-Loks on a cylinder of oxidized cellulose gauze, with the intent of avoiding the risk of tissue fracture caused by the suture itself. Bleeding was thus controlled. The patient experienced an uneventful course and was discharged on postoperative day 26. Conclusions. According to the recent literature, graft nephrectomy for KAR is no longer considered the standard surgical treatment. A new approach to rupture repair has been proposed, providing good rates of graft and patient survival.
S
PONTANEOUS kidney allograft rupture (KAR) is a serious complication of kidney transplantation (KT) that potentially threatens graft and patient survival. The first early spontaneous renal graft ruptures were reported by Haberal et al [1]. According to the literature, the incidence of KAR is w0.8% to 6%. KAR is frequently associated with several conditions, the most common of which are acute rejection, acute tubular necrosis, vascular thromboses, hypertension, traumas, and infections [2]. Surgical treatment strategies consist of transplantectomy or surgical repair. Different parenchymal repair methods have been reported previously. We describe for the first time a new surgical approach to adopt in case of KAR.
sudden abdominal pain in the left iliac fossa associated with hypotension, oliguria, and anemia (hemoglobin, 7.8 g/dl). Ultrasounds detected perinephric fluid collection. An immediate laparotomy revealed the presence of a large extraperitoneal hematoma with a concomitant 4-cm linear kidney rupture (Fig 1A). KAR was sutured with an absorbable polyglycolic acid suture, stopping each stitch by Hem-o-Loks placed on a cylinder of oxidized cellulose gauze. After the suturing, bleeding was controlled. A TachoSil sponge (Baxter, Illinois, USA) was finally placed at the level of the suture (Fig 1B). The patient had an uneventful course and was discharged on postoperative day 26 with a blood urea nitrogen level of 58 mg/dl and a serum creatinine concentration of 1.3 mg/dl. Two years after KT, the patient is alive with normal renal function.
DISCUSSION CASE REPORT A 53-year-old man underwent a deceased-donor KT due to endstage renal disease caused by diabetic nephropathy. The donor was 44 years old. Panel reactive HLA for antibodies was
