Management of Grade IV Renal Graft Trauma Secondary to Oncological Surgery: A Case Report

Abstract

Renal graft injury is a challenging condition that can endanger function or become a life-threatening event. Although the most common cause of renal graft injury is trauma, some cases of injuries associated with surgical procedures have been described. Here, we present a case of a transplant patient who experienced a grade IV renal graft injury after an open oophorectomy. A 31-year-old woman received a renal transplant from a cadaveric donor. During her follow-up, a multilocular cyst with a solid mural nodule tumor of the left ovary was documented, with an 84% risk for malignancy as determined by the International Ovarian Tumour Analysis score. Therefore, an open unilateral (left) oophorectomy was scheduled. The patient was readmitted 2 days after surgery and was hemodynamically stable despite intense pain in the right iliac fossa, sudden creatinine elevation, and hematuria. Tomography revealed a peri-graft hematoma with a mass effect. An exploratory laparotomy was performed, and 2 lacerations with an exposed collecting system and without urinary leakage were identified. These were repaired with absorbable barbed sutures reinforced with Teflon patches on the edges, with cellulose hemostatic mesh and fibrin adhesive on top of these patches. In the postoperative period, creatinine decreased to its baseline levels, but a urinary leak was noted, which was corrected by ureteral stent placement. The management of renal graft trauma requires closer monitoring and stricter criteria for reaching a definitive therapeutic decision to prevent the deterioration of the graft and the patient.