Renal allograft rupture caused by acute tubular necrosis.
Renal allograft rupture is a rare but potentially lethal complication of kidney transplantation. A renal allograft recipient receiving quadruple immunosuppressive therapy developed a spontaneous allograft rupture 13 days after kidney transplantation. Warm ischaemia time during the transplant was 80 minutes. The ruptured kidney graft could not be salvaged because of the patient's haemodynamic instability. The histopathological examination showed interstitial oedema with severe acute tubular necrosis with no signs of acute rejection. The most common causes of renal graft rupture are acute rejection and vein thrombosis, while acute tubular necrosis may only rarely be responsible for this complication. Renal graft rupture may be the result of interstitial damage attributed both to the prolonged warm ischaemia time during the transplant and to post-transplant acute tubular necrosis in the absence of graft rejection. In those patients whose haemodynamic status cannot be stabilized by appropriate aggressive haemodynamic support therapy, graft nephrectomy should be considered the only definitive treatment.
Department of Surgery, Transplantation and Advanced Technologies, Kidney Transplant Unit, University Hospital of Catania, Via S. Sofia, 78-95123 Catania.
Massimiliano
M
Veroux
Pierfrancesco
P
Veroux
Carmelo
C
Puliatti
Pietro
P
Fiamingo
Maurizio
M
Macarone
Dario
D
Cappello
D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology; D016030:Kidney Transplantation; D007683:Kidney Tubular Necrosis, Acute / Q000150:complications*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012422:Rupture, Spontaneous