Unusual cause of early graft dysfunction after kidney transplantation.
OBJECTIVE
Transplant renal artery stenosis usually develops in the later period after renal transplantation and is usually due to atherosclerosis and fibrosis at the anastomosis. A kinking renal artery stenosis, however, is a rare cause of early graft dysfunction.


METHODS
In a 34-year-old-man early graft failure developed within 1 week after kidney transplantation. In the presence of histologically proven ischemic damage an arterial kinking stenosis was diagnosed by color Doppler sonography. Selective arteriography confirmed the sharp kinking of the transplant renal artery; however, a significant stenosis could not be visualized by arteriography.


RESULTS
Due to progressive loss of renal function surgical resection of scar tissue in the kink of the transplant artery and nephropexy was performed. Immediately thereafter graft function and blood pressure significantly improved so that the successful clinical outcome of this unusual case of early graft failure confirmed the relevance of the arterial kinking stenosis.


CONCLUSIONS
In this unusual case of early graft dysfunction relevant kinking renal artery stenosis could not be adequately visualized by arteriography, although color Doppler sonography clearly demonstrated the stenosis. Therefore, both methods should be considered if parenchymal causes of graft dysfunction are excluded by biopsy and a kinking renal artery stenosis is suspected.
Krumme
B
B
Department of Internal Medicine IV, University Hospital Freiburg, Germany. krumme@mm41.ukl.uni-freiburg.de
Pisarski
P
P
Blum
U
U
Kirste
G
G
Schollmeyer
P
P
D000328:Adult; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D011859:Radiography; D012078:Renal Artery Obstruction / Q000150:complications* / Q000000981:diagnostic imaging; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color