Spontaneous renal allograft rupture is one of the most dangerous complications of kidney transplantation which can result in graft loss. It could happen in the first few weeks after renal transplantation. Its prevalence varies from 0.3% to 3%. The conditions predisposing to this event are acute rejection and renal vein thrombosis. Nephrectomy is the preferred management .However, there are recent reports suggesting this kidneys could be saved through repair of ruptured kidney.In this article we report our experience about management of spontaneous allograft rupture. M&M. Of the total number of 1682 kidney transplantations performed in our center from 1986 through 2003, six (0.35%)patients developed renal allograft rupture, all preceded by acute rejection. The time interval betweenallograft rupture and renal transplant varied from 4to13 days, with the mean duration of 6.3 days. The major clinical presenting symptom was severe, sudden-onset pain, swelling and tenderness at the site of renal allograft associated with tacchycardia and hemodynamic instability. In all patients graft ultrasound showed extensive perirenal hamatoma suggesting graft rupture. All six patients were treating with antirejection medications. Immidiate exploration was performed in all patients after hemodynamic stabilization. In 3 cases which was done by a single surgeon, nephrectomy was done because of extensive, multiple ruptures, but in other 3 cases ,conducted by a different surgeon, grafted kidney was saved through reparing of the tears by 2/0 vieryl sutures and fat or surgicell interposition.
In three patients undergone repair of allograft rupture, remarkable improvement of graft function was noted following operation. Two patients did not experience any complication and discharged two weeks after repair with serum creatinine level of 1.4mg/dl.Unfortunately, the third patient developed wound infection and dehiscence and finally succumbed due to septic shock four weeks after graft repair. In those patients undergone nephrectomy, no postoperative complication was
observed and they returned to hemodialysis.
Kidney allograft rupture is one of the most devastating complications of renal transplantation. In most cases the antecedent event is acute graft rejection and renal vein thrombosis. It is an emergency situation mandating immediate surgical intervention. In every condition the surgeon have to try to concern repair of ruptured kidney as the first management.