Renal allograft rupture

Abstract

In the present material of 448 consecutive renal transplants the incidence of allograft rupture was 3.6%. Among 389 first transplants there were two ruptures in the living donor group (126 patients, 1.5%) and 12 ruptures in the cadaveric donor group (263 patients, 4.6%). Only one ruptured kidney (living donor) achieved long term function. Four patients with first graft rupture were retransplanted with early loss of the kidney in all, in two because of rupture. Two of these patients received a 3rd cadaveric graft, of which one is functioning well after two years. All ruptures occurred within three weeks after transplantation, 14 kidneys ruptured during the first week. The clinical course and the operative findings suggested that rejection was the cause of rupture in all cases. This was confirmed by light and immunofluorescent microscopy of specimens from 15 kidneys, while one kidney only demonstrated extensive intrarenal vessel thrombosis. It is concluded that renal allograft rupture signals a strong immunological response in the recipient with poor graft prognosis. The chance of a successful retransplantation is small.