Korean J Transplant.  2020 Jun;34(2):126-131. 10.4285/kjt.2020.34.2.126.

Allograft dysfunction and parenchymal necrosis associated with renal artery stenosis and perigraft hematoma after kidney transplantation

• Kim HS
• Lee JH
• Lee DY
• Kim HY
• Kim DH
• Oh JS
• Sin YH
• Kim JK
• Hwang SD

• KMID: 2503891
• DOI: http://doi.org/10.4285/kjt.2020.34.2.126

Abstract

Transplant renal artery stenosis (TRAS) is one cause of allograft dysfunction. TRAS causes parenchymal necrosis and graft insufficiency. Herein, we report the case of a 40-year-old female with end-stage renal disease due to immunoglobulin A nephropathy, who underwent kidney transplantation with her elder sister. The surgery was successful and the allograft showed primary graft function. At postoperative day (POD) 2, urine output decreased sharply. We checked a non-enhanced abdominal computed tomography scan which showed subcapsular and pelvic cavity hematomas. She underwent hematoma removal surgery with renal upper polar capsulotomy. Bleeding control was successful, but her serum creatinine was 5.4 mg/dL. At POD 25, abdomen magnetic resonance angiography showed significant stenosis at the anastomosis site between the graft renal artery and the recipient’s internal iliac artery. Then, percutaneous transluminal angioplasty was implemented. Significant stenosis (>80%) was detected at the anastomotic site and a 5-mm stent was inserted at stenotic lesion with post-stent balloon angioplasty using a 5-mm balloon catheter. The renal arterial diameter and blood flow were normalized. At postoperative 5 months, a 99mTc dimercaptosuccinic acid scan showed multiple focal radioisotope defects. At 54 months after renal transplantation, her serum creatinine level was 4.0 mg/dL and her glomerular filtration rate was 13 mL/min/1.73 m². Hence, we report that TRAS can cause parenchymal necrosis and allograft dysfunction.

Keyword

Kidney transplantation; Transplant renal artery stenosis; Graft dysfunction

Figure

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  Fig. 1 Abdominal computed tomography: peri-graft and peri-bladder hematoma (arrows).

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  Fig. 2 Allograft ultrasonography (postoperative day 24) showing slurred peak systolic velocity.

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  Fig. 3 Magnetic resonance angiography: transplant renal artery stenosis (arrow) and focal parenchymal necrosis (arrowheads).

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  Fig. 4 Allograft angiography: anastomosis stenosis, 80% (arrow).

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  Fig. 5 Allograft angiography: postpercutaneous transluminal angioplasty and stent deployment (arrow).

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  Fig. 6 Allograft ultrasonography (postoperative day 45) showing slightly increased peak systolic velocity.

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  Fig. 7 Dimercaptosuccinic acid scan: multiple focal radioisotope defects (arrowheads). LPO, left posterior oblique; RPO, right posterior oblique.

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  Fig. 8 Clinical course. s-Cr, serum creatinine; U-vol, urine volume; op, operation.

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