Abstract
Vascular torsion in a renal allograft after placement in the retroperitoneum is rare and has only been reported twice in the literature. It is an extrinsically mediated process that occurs at the vascular pedicle resulting in graft compromise and potential loss. Rapid diagnosis and immediate surgical intervention may salvage allograft function. Herein, we present a unique case of a 42-year-old male that developed renal allograft torsion following a second kidney transplant placed in the retroperitoneum. Immediate detorsion did not resolve allograft dysfunction, and a biopsy revealed acute cellular mediated rejection. After antithymocyte globulin treatment, allograft function was salvaged. A review of the current literature shows that the incidence, morbidity, and long term allograft function of intraperitoneal and extraperitoneal torsion are different. As such, torsion of the retroperitoneal kidney demonstrates encouraging allograft salvage rates. Only the third case reported to date, this serves as a contribution to the growing body of literature in retroperitoneal renal torsion and reviews the risks, medication considerations, diagnostic tests, and treatment modalities in a unique disease process.
Highlights
Reported short-term complications following kidney transplant include postoperative hemorrhage, thrombosis, urine leak, ureteral stricture, and acute rejection [1, 2]
Vascular torsion is an extrinsically mediated, rare, and potentially reversible complication that occurs at the vascular pedicle resulting in graft compromise and/or loss
Two reports of vascular torsion in a renal allograft have been reported in retroperitoneal transplants [6, 7]
Summary
Reported short-term complications following kidney transplant include postoperative hemorrhage, thrombosis, urine leak, ureteral stricture, and acute rejection [1, 2]. Thrombosis can occur from intrinsic mediators or extrinsic factors that compromise vascular inflow or outflow [3]. Vascular torsion is an extrinsically mediated, rare, and potentially reversible complication that occurs at the vascular pedicle resulting in graft compromise and/or loss. We present a case complicated by renal torsion and subsequent acute rejection. Recognition and treatment of both complications allowed for successful salvage of the graft. This case serves as only the third report of renal hilar torsion in retroperitoneal placement of a kidney allograft [6, 7]
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