Torsion of Extraperitoneally Transplanted Kidney: An Unusual Complication

Özmen, Mehmet Mahir; Bilgiç, İsmail; Zıraman, İpek; Koç, Mahmut

doi:10.6002/ect.2012.0089

Cited by 12 publications

(16 citation statements)

References 12 publications

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“…Only two reports of vascular torsion in a renal allograft have been reported in retroperitoneal transplants [6, 7]. The majority of vascular torsion has been reported in the intra-abdominally placed kidney associated with simultaneous pancreas kidney (SPK) transplants [8].…”

Section: Discussionmentioning

confidence: 99%

“…Including color flow Doppler imaging is a rapid, inexpensive, and accurate method of assessing vascular patency. The overall sensitivity of this method when evaluating the renal pedicle is 95%, with specificity of 92% [6]. Computerized tomography angiography (CTA) and magnetic resonance imaging angiography (MRA) are superior methods of imaging but are costly and may delay intervention in the acute setting.…”

Section: Discussionmentioning

confidence: 99%

“…Early 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]. …”

Section: Introductionmentioning

confidence: 99%

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Torsion of the Retroperitoneal Kidney: Uncommon or Underreported?

Sosin

Lumeh

Cooper

2014

Case Reports in Transplantation

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Torsion of the Retroperitoneal Kidney: Uncommon or Underreported?

Sosin

Lumeh

Cooper

2014

Case Reports in Transplantation

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“…Only three other cases of retroperitoneal renal allograft torsion have been reported in the literature. In 2009, Ozmen et al suspected malposition of the kidney when urine output dropped significantly on postoperative day 5, leading to the identification of allograft torsion on ultrasound (Table 1) [2]. Winter et al described a case of torsion they believe resulted from the patient's increased BMI and error in surgical technique [4].…”

Section: Discussionmentioning

confidence: 99%

“…Torsion of kidneys transplanted into the retroperitoneal space is a rare complication. Only three other cases have been reported, all within the last ten years [2][3][4]. These cases represent examples of warm ischemic time in kidney transplants.…”

Section: Introductionmentioning

confidence: 99%

Salvage after Retroperitoneal Kidney Allograft Torsion

Greco

Mulligan

Yoo

2020

Case Reports in Transplantation

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Torsion of a transplanted kidney into the retroperitoneal space is a rare occurrence, with only three other reported cases. Failure after kidney transplantation is caused by surgical, immunological, and infective complications. Torsion is a complication that poses a serious risk of ischemic graft failure, and, if suspected, sonographic evaluation helps ascertain the diagnosis. Here, we present the case of a 69-year-old transplant recipient whose routine postoperative ultrasound confirmed vessel patency, however subsequently developed clinical signs of renal allograft compromise. Repeat ultrasound showed signs of vascular compromise and the patient was emergently re-explored. Torsion of the renal allograft about its pedicle was encountered and corrected by manual detorsion and nephropexy to the retroperitoneal wall. Clinicians should recognize pedicle torsion as a potential cause of renal allograft failure and the role of nephropexy in its management.

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Transplant with a twist: A pitfall in sonographic diagnosis of renal transplant torsion

Narasimhan

Kennedy

Campsen

2017

J of Clinical Ultrasound

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Torsion is an uncommon cause of impaired function in a renal transplant. We present a case of intraperitoneal transplant torsion secondary to adhesions to the left fallopian tube and ovary. Inability to confirm renal venous flow with Doppler misled to the erroneous sonographic diagnosis of renal vein thrombosis, although end diastolic flow was absent rather than reversed. The correct diagnosis was made with CT. The combination of abnormal orientation of the graft on ultrasonography, acutely impaired renal function, and abnormal Doppler study should have led to a diagnosis of transplant torsion. The case is also unusual in that the lead point was adnexal pathology. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:528-530, 2017.

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Torsion of Extraperitoneally Transplanted Kidney: An Unusual Complication

Cited by 12 publications

References 12 publications

Torsion of the Retroperitoneal Kidney: Uncommon or Underreported?

Torsion of the Retroperitoneal Kidney: Uncommon or Underreported?

Salvage after Retroperitoneal Kidney Allograft Torsion

Transplant with a twist: A pitfall in sonographic diagnosis of renal transplant torsion

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