title: Late spontaneous kidney graft decapsulation after administration of sirolimus in a recipient with chronic hepatitis B and C infection: a case report.
abstract: Late spontaneous kidney graft decapsulation with fluid collection is a rare condition with only a few cases reported in the literature. Common causes of renal allograft rupture include acute rejection, acute tubular necrosis, renal vein thrombosis, and trauma. Sirolimus related late spontaneous decapsulation has not been reported in the past. Interestingly, sirolimus may promote lymphocele formation in renal transplant recipients, including those presenting with chronic hepatitis B or C. Herein, we report a case of late spontaneous decapsulation with subcapsular hematoma formation developing 12 years after receipt of a cadaveric allograft. The patient was infected with both hepatitis B and C viruses. Cyclosporine was replaced by sirolimus for maintenance therapy because of chronic rejection and acute deterioration of renal function. He presented to the hospital at 9 months after sirolimus inception because of a sudden onset of pain and swelling over the kidney graft. Magnetic resonance imaging found the capsule to be stripped from the kidney by a collection of liquefied hematomas. A laparoscopic fenestration was performed by creation of a peritoneal window adjacent to the renal allograft. When patients have chronic hepatitis, tacrolimus might be a better choice than sirolimus.
authors.affiliation: Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan.
authors.forename: M-H
authors.initials: MH
authors.lastname: Yang
authors.forename: C-C
authors.initials: CC
authors.lastname: Loong
authors.forename: C-W
authors.initials: CW
authors.lastname: Wu
authors.forename: W-Y
authors.initials: WY
authors.lastname: Lui
mesh_terms: D050476:Bowman Capsule / Q000473:pathology / Q000601:surgery; D002102:Cadaver; D003404:Creatinine / Q000097:blood; D005921:Glomerulonephritis / Q000601:surgery; D019694:Hepatitis B, Chronic / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology / Q000473:pathology / Q000502:physiology*; D007683:Kidney Tubular Necrosis, Acute / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D012077:Renal Artery / Q000000981:diagnostic imaging; D020123:Sirolimus / Q000627:therapeutic use*; D014019:Tissue Donors; D014463:Ultrasonography
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine; D020123:Sirolimus