title: Salvaging of severely ruptured living-related renal allograft secondary to acute antibody mediated rejection.
abstract: BACKGROUND
  Spontaneous renal allograft rupture (RAR) is a serious and potentially life-threatening complication of kidney transplantation. Debate on the management of RAR has focused on graft nephrectomy versus salvaging in cases where: the allograft rupture site is surgically manageable; the bleeding can be controlled; and/or leaving the renal allograft in situ does not compromise patient survival.
  
  
  METHODS
  A 45-year-old, living-related, female, kidney allograft recipient experienced RAR on the fourth day post transplantation. Surgical exploration showed 12cm laceration along the convex border of the graft. Histologically the graft demonstrated mild acute kidney injury and linear deposition of C4d along the cortical peritubular capillaries; morphological features for violent humoral or cellular rejection were not identified. The graft was surgically salvaged with excellent clinical and biochemical improvement.
  
  
  CONCLUSIONS
  Observations arising from this case are: (1) RAR caused by rejection is still encountered in clinical practice despite effective immunosuppressive management; (2) the severity of the histopathological features of rejection does not necessarily correlate with the extent of graft rupture; and (3) salvaging the graft should be attempted whenever possible as current immunosuppression and advances in surgical techniques may have an impact on long-term graft function and survival, differing from those previously published.
  
  
  CONCLUSIONS
  With modern immunosuppression therapy and proven surgical procedures, the efficacy of salvaged renal grafts and graft survival rates may improve substantially.
authors.affiliation: Department of Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Almarastani
authors.affiliation: Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
authors.forename: Noura
authors.initials: N
authors.lastname: Aloudah
authors.affiliation: Department of Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Hamshow
authors.affiliation: Department of Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Bassem
authors.initials: B
authors.lastname: Hegab
authors.affiliation: Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Electronic address: saadkh@ngha.med.sa.
authors.forename: Khaled O
authors.initials: KO
authors.lastname: Alsaad
keywords: Allograft rupture; Antibody-mediated rejection; Graft; Renal allograft rupture; Transplant complications