Torsion of intraperitoneal kidney transplant

Abstract

A prompt consideration of the diagnosis of torsion of kidney transplant is required to prevent delay in surgical intervention. We recommend urgent Doppler ultrasound be used as first-line investigation, followed by prompt surgical exploration. We recommend the use of prophylactic nephropexy to prevent torsion.

Post-transplantation nephroptosis causing recurrent episodes of acute renal failure and hypertension secondary to intermittent vascular torsion of intraperitoneal renal allograft

“…Presenting symptoms of nephroptosis most commonly include AKI, abdominal pain, decreased urine output and nausea/vomiting [3]. Doppler studies may reveal elevated flow velocities or complete occlusion of the vascular pedicle, but may also be normal if there is no active torsion of the renal allograft.…”

“…Prophylactic suture nephropexy may be undertaken at the time of transplantation to reduce the risk of post-operative nephroptosis [3]. We now routinely perform this during intra-abdominal renal transplants at our institution.…”

Torsion of the Retroperitoneal Kidney: Uncommon or Underreported?

“…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]. The purported risk factors for intraperitoneal renal torsion include pediatric transplant recipients, patients with Prune Belly syndrome, and patients taking chronic corticosteroids [9–14].…”

“…Immunosuppressive medication is believed to induce an adhesion-free intraabdominal environment, acknowledging a potential role for nephropexy to adjacent structures. Although multiple authors recommend prophylactic nephropexy for SPK transplantation, there is a paucity of data to support it in retroperitoneal kidney transplantation [8, 12, 13]. Modi et al have reported 2 of 6 patients undergoing a laparoscopic kidney transplant without nephropexy developed renal torsion and subsequently underwent nephrectomy.…”

“…Rates of graft salvage after detorsion are approximately 44%. Immediate nephrectomy has been reported in 38% of torsion cases, with 19% of delayed allograft loss following detorsion [8]. Exclusive to intraabdominal torsion, these rates differ from retroperitoneal torsion case reports.…”