Surgical repair of spontaneous renal allograft rupture: a new procedure.
BACKGROUND
The purpose of the present paper is to introduce a new surgical procedure using the external oblique aponeurosis (EOA) for repair of spontaneous renal allograft rupture.


METHODS
Thirty-eight cases with spontaneous renal allograft rupture were encountered in 1000 consecutive kidney transplants between April 1991 and August 2000. Thirty-three cases underwent surgical exploration with two grafts undergoing nephrectomy, while a further 31 were repaired using the new surgical procedure. The external oblique aponeurosis (EOA) from the incision was trimmed into 1 cm x 1 cm square pieces. A 2/0 Dexon suture was placed through each piece of the EOA, then through the parenchyma of the kidney perpendicular to the rupture. Each suture was then placed through another piece of EOA and tied.


RESULTS
Two repaired grafts were removed on day 7 and day 10, one due to graft re-rupture and another with ischaemia secondary to irreversible acute rejection. The graft function of 29 cases had recovered completely at 30 days following surgical repair with one graft improving rapidly. Thirteen grafts were diagnosed as undergoing mild to moderate acute rejection, whereas a further 20 cases were considered to have acute tubular necrosis on histopathology. The allograft survival rate at 1 year and 5 years post grafting was 86% and 64%, respectively. No patients died from postoperative complications following repair using this procedure.


CONCLUSIONS
Spontaneous renal allograft rupture is a relatively common post-transplant complication secondary to either acute tubular necrosis or acute rejection. This new surgical procedure is proposed as a reliable and practical method of repair following graft rupture. Preservation of graft function and viability following rupture appears achievable both in the medium and long-term.
He
Bulang
B
Institute of Urology, Beijing Chaoyang Hospital, Beijing, China. hebul@hotmail.com
Rao
M Mohan
MM
Han
Xiuwu
X
Li
Xiaobei
X
Guan
Delin
D
Gao
Juzhong
J
D006801:Humans; D007668:Kidney / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D013536:Suture Techniques; D014184:Transplantation, Homologous; D013520:Urologic Surgical Procedures