Allograft loss from acute Page kidney secondary to trauma after kidney transplantation

Abstract

We report a rare case of allograft loss from acute Page kidney secondary to trauma that occurred 12 years after kidney transplantation. A 67-year-old Caucasian male with a past surgical history of kidney transplant presented to the emergency department at a local hospital with left lower abdominal tenderness. He recalled that his cat, which weighs 15 lbs, jumped on his abdomen 7 d prior. On physical examination, a small tender mass was noticed at the incisional site of the kidney transplant. He was producing a normal amount of urine without hematuria. His serum creatinine level was slightly elevated from his baseline. Computer tomography revealed a large subscapular hematoma around the transplant kidney. The patient was observed to have renal trauma grade II at the hospital over a period of three days, and he was finally transferred to a transplant center after his urine output significantly decreased. Doppler ultrasound demonstrated an extensive peri-allograft hypoechoic area and abnormal waveforms with absent arterial diastolic flow and a patent renal vein. Despite surgical decompression, the allograft failed to respond appropriately due to the delay in surgical intervention. This is the third reported case of allograft loss from acute Page kidney following kidney transplantation. This case reinforces that kidney care differs if the kidney is solitary or a transplant. Early recognition and aggressive treatments are mandatory, especially in a case with Doppler signs that are suggestive of compression.

Keywords: Doppler ultrasound; Kidney transplantation; Page kidney; Subcapsular hematoma; Trauma.

Figure 1

Computed tomography without intravenous contrast of the transplanted kidney. A: Coronal view; B: Sagittal view. A subscapular hematoma 12 cm × 2.5 cm in size was compressing the transplanted kidney (arrows).

Figure 2

Presence of peri-allograft hematoma and Doppler ultrasound findings. A: Transplant arterial flow. Peri-allograft hypoechoic area (arrows) with absent diastolic flow in the arcuate arteries; B: Transplant venous flow. The transplant renal vein was patent.