Renal Allograft Torsion Following Simultaneous Pancreas Kidney Transplant Should Be Suspected With Sustained Kidney Injury With Normal Pancreas Function

Torabi, Julia; Rocca, Juan P.; Choinski, Krystina; Lorenzen, Katherine A.; Ajaimy, Maria; Graham, Jay A.

doi:10.1177/1526924818800041

Cited by 6 publications

(5 citation statements)

References 3 publications

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“…Interestingly, of the 8 kidney transplants performed without pancreatic transplantation, 3 of these allografts were placed extraperitoneally and experienced torsion in the early postoperative period [ 14 – 16 ]. Some clinicians have proposed that intraperitoneal placement increases the risk of mobility with subsequent torsion and recommend that prophylactic nephropexy should be performed for patients who require an intraperitoneal kidney transplant [ 12 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Kidney allograft torsion results in a high rate of allograft loss, with only 58% of allografts salvaged (15 of 26) [ 7 , 8 , 11 – 21 ]. Successful management depends on rapid diagnosis and surgical correction to limit ischaemic time and, as in our case, can result in a favourable allograft outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Case Reports in Nephrology Some clinicians have proposed that intraperitoneal placement increases the risk of mobility with subsequent torsion and recommend that prophylactic nephropexy should be performed for patients who require an intraperitoneal kidney transplant [12,21]. Kidney allograft torsion results in a high rate of allograft loss, with only 58% of allografts salvaged (15 of 26) [7,8,[11][12][13][14][15][16][17][18][19][20][21]. Successful management depends on rapid diagnosis and surgical correction to limit ischaemic time and, as in our case, can result in a favourable allograft outcome.…”

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confidence: 99%

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Simultaneous Pancreas-Kidney Transplant Complicated by Kidney Allograft Torsion and Pseudoaneurysms of the Y-Allograft: A Case Report and Review of the Literature

Tan

Cehic

et al. 2022

Case Reports in Nephrology

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Background. We report and review the literature of two rare complications of simultaneous pancreas-kidney transplantation (SPKT) occurring in one patient. Case Report. A 39-year-old man with dialysis-dependent kidney failure secondary to type 1 diabetes mellitus underwent successful SPKT in October 2018. Three months later, he presented with an acute kidney injury (AKI) and returned to dialysis. Kidney scintigraphy showed a central photopenic region, and angiograms showed absent flow in the kidney transplant artery without treatable thrombus and the incidental finding of two pseudoaneurysms of the pancreatic Y-graft. He remained dialysis-dependent for three weeks before spontaneous partial recovery of allograft function; repeat kidney scintigraphy showed significant improvement in perfusion. However, in April 2019 he was readmitted with a sudden deterioration in kidney allograft function again necessitating haemodialysis. Repeat imaging confirmed that the kidney allograft had shifted from the left iliac fossa to the midline. He underwent surgical exploration, during which torsion of the kidney allograft was confirmed and a nephropexy was performed. The kidney allograft was originally implanted in the left retroperitoneum via a midline transperitoneal approach, which likely predisposed it to torsion. The pseudoaneurysms of the pancreatic Y-graft were managed conservatively, and surveillance imaging demonstrated that they remained stable in size. The patient regained reasonable kidney allograft function (estimated glomerular filtration rate, eGFR, of 45 mL/min) and maintained normal pancreatic allograft function. Conclusion. Kidney allograft torsion should be considered post-SPKT in patients with AKI and absent arterial flow. Although most case reports describe surgical management of pseudoaneurysms post-SPKT, our case demonstrates successful conservative management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Simultaneous Pancreas-Kidney Transplant Complicated by Kidney Allograft Torsion and Pseudoaneurysms of the Y-Allograft: A Case Report and Review of the Literature

Tan

Cehic

et al. 2022

Case Reports in Nephrology

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“…Kidney allograft torsion is a rare complication of kidney transplant that can lead to allograft loss from prolonged ischemia if not quickly corrected with detorsion and nephropexy. This complication has primarily been reported in adult transplant patients who have intraperitoneal placement of the renal allograft in the setting of simultaneous kidney‐pancreas transplantation 1–7 . In pediatric patients, there have been two cases of renal allograft torsion reported, both in patients with prune belly syndrome and intraperitoneal transplants with torsion occurring about 2 months post‐transplant 8,9 …”

Section: Introductionmentioning

confidence: 99%

“…This complication has primarily been reported in adult transplant patients who have intraperitoneal placement of the renal allograft in the setting of simultaneous kidney-pancreas transplantation. [1][2][3][4][5][6][7] In pediatric patients, there have been two cases of renal allograft torsion reported, both in patients with prune belly syndrome and intraperitoneal transplants with torsion occurring about 2 months post-transplant. 8,9 Kidney allografts in appropriately sized patients are preferentially placed retroperitoneally in the right iliac fossa due to the more superficial position of the external iliac vein, which limits mobility of the allograft.…”

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confidence: 99%

Late renal allograft torsion in a pediatric transplant recipient

Hsiao

Abt

Amaral

et al. 2021

Pediatric Transplantation

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Background Kidney allograft torsion is a rare complication of kidney transplant that can lead to allograft loss from prolonged ischemia if not quickly corrected with detorsion and nephropexy. We report a case of late intraperitoneal renal allograft torsion in a pediatric transplant recipient. Case Report The patient is a 7‐year‐old male with a history of end‐stage renal disease secondary to renal dysplasia in the setting of bilateral high‐grade vesicoureteral reflux. He underwent bilateral native nephrectomies for recurrent pyelonephritis and right ureteral kink with urinary tract obstruction. Torsion occurred 3 years after transplant in the setting of one day of emesis, loose stool, severe abdominal pain, and decreased urine output. Diagnosis of transplant torsion was suspected on non‐contrast CT scan done after transplant Doppler ultrasound showed no flow to the allograft. The CT scan showed that the kidney had been medialized and renal hilum was flipped from the expected orientation. The patient required a transplant nephrectomy. Conclusions Renal transplant torsion is a rare event but should be suspected in any renal transplant recipient with acute onset of abdominal pain, acute kidney injury, and decreased urine output, regardless of length of time from transplantation. Patients suspected to have renal torsion should be evaluated emergently with a transplant ultrasound Doppler.

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