Korean J Transplant.  2022 Nov;36(Supple 1):S113. 10.4285/ATW2022.F-2321.

An unusual cause of acute kidney injury after kidney transplant

• Singh JI
• Dutta A
• Sengupta P

• KMID: 2535629
• DOI: http://doi.org/10.4285/ATW2022.F-2321

Abstract

Leak of urine from allograft kidney is a rare surgical complication post kidney transplant, generally occurring in the immediate post-op period and usually from the lower ureter. We present an unusual case where it occurred from upper ureter and 6 weeks posttransplant in the background of acute rejection. A 25-year-old male suffering from stage 5 CKD on maintenance hemodi-alysis thrice a week for an year, underwent living donor ABO-compatible kidney transplant with mother as donor. He had low immunological risk, hence started on triple immunosuppression without any induction. Laparoscopic donor nephrectomy was performed uneventfully. The immediate postoperative recovery was uneventful with progressive decline in creatinine. He suffered an acute cellular rejection a week after transplant which resolved with methylprednisolone IV pulse and anti-thymo-cyte globulin therapy. His creatinine settled to 1.4 mg/dL. Double-J (DJ) stent removal was done at 4 weeks posttransplant. Three days later his creatinine started rising again with preserved urine output. Repeat allograft biopsy showed acute cellular and antibody mediated rejection. He underwent five sessions of plasmapheresis along with low dose IVIg. He became oliguric with progressive abdominal distension and scrotal swelling. Examination was suggestive of free fluid in abdomen. Creatinine increased to 9 mg/dL. Ultrasonography showed massive ascites and normal graft kidney. Ascitic fluid was clear and transudative with a creatinine of 7 mg/dL. A dynamic nuclear medicine scan was done for evaluation of possible urine leak. The scan revealed ongoing urine leak from the upper ureter and renal pelvis. A DJ stent was re inserted followed by brisk diuresis and decline in creatinine to 1.0 mg/dL. The ascites resolved spontaneously and DJ stent was removed after 6 weeks. The case high-lights the important role of a nuclear medicine scan in suspected urine leak and delineating the location.