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Salvage of Renal Graft after Acute Torsion Following Simultaneous Kidney-Pancreas Transplantation

Abstract:

Torsion of a renal allograft after simultaneous kidney-pancreas (SKP) transplantation is a rare complication. When it does occur, subsequent loss of the renal allograft is expected. Herein we present a 26-year-old Hispanic male who received a SKP transplant through a midline incision. He presented 8 months post-transplant with acute onset of abdominal pain, a palpable midline mass, diminished urine output, and serum creatinine elevated threefold over the baseline level. The patient was taken immediately to surgery where de-torsion and "nephro-pexy" to the lateral parietal peritoneal space took place. Dialysis was necessary for 1 month, after which renal function returned to baseline. A high index of suspicion, rapid diagnosis, and corrective surgery can be effective in renal allograft salvage in selected cases of torsion. When SKP is performed through midline incision, we recommend pexy of the kidney allograft to the lateral parietal peritoneal wall to avoid graft torsion.