Renal packing for management of transplanted kidney blunt trauma: a case report and a review of literature

Abstract

The kidney is injured in up to 10% of patients who experience significant abdominal trauma and approximately 65% of genitourinary tract injuries involve the kidney. Less is known about the management of this kind of trauma in the case of a transplanted kidney, and for this reason, we performed a review of the current literature. A systematic search was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses in all electronic databases; the inclusion criteria regarded all studies reporting on blunt trauma of a transplanted kidney, and the main outcome was the surgical or conservative management strategy of the trauma. A total of eight studies were included in the review and they were all case reports. We also reported our experience of a case of a 51-year-old patient with blunt trauma to his 18-year-old transplanted kidney, who underwent temporary packing of the renal fossa for kidney salvage. Trauma to a transplanted organ is rare, but clinicians will increasingly confront this scenario with the rise in transplantations. Although the management of renal trauma is well established, we are still far from identifying a gold standard for the treatment of transplanted kidney blunt trauma. It has been demonstrated that outcomes for trauma patients with previous organ transplants are not worse than nontransplanted patients; from this point of view, damage control surgery is considered an adequate approach and is applicable to unstable patients unfit for conservative or radiological intervention, and also in the case of a previous transplant. Data from this review and our experience demonstrate that accurate diagnostic profiling and the correct surgical management can allow the transplanted organ to be saved through a damage control approach; compliance with the most up-to-date therapeutic protocols must always guide surgical choices and, in our case, has allowed us to preserve the graft improving the patient’s quality of life.