SPONTANEOUS RENAL ALLOGRAFT RUPTURE OF UNKNOWN ETIOLOGY: A CASE REPORT

Introduction: Rupture of renal allograft is a rare but serious complication of transplantation. This is usually attributed to acute rejection, acute tubular necrosis, or renal vein thrombosis.Some other causes like renal graft biopsy and lymphatic obstruction are also mentioned as possible causes. This usually occurs during the first 1-3 weeks following transplantation, but cases occurring as late as 72 months have been reported. Case: A 23 yearold male with established chronic kidney disease stage 5(CKD V), underwent live related renal transplantation (LRRT) using kidney from a 46 year old donor (Mother). The laparoscopic donor nephrectomy was uneventful. Patient had an uneventful intraoperative course with usual early postoperative recovery. The patient was having a good early post operative course. On POD 2 there was sudden decrease in urine output to 100 ml/hr. USG Doppler on the same day evening showed normal color flow in renal artery and renal vein. At around 7 pm, there was sudden increase in drain output with fresh blood as content (500 ml in 10 mins) with tachycardia and hypotension. In view of increased drain output, patient was taken to OR and re exploration was done. At re exploration, the renal allograft was found to have two longitudinal ruptures of around 8?1?2 and 5?1?1 cms(Length?Width?Depth)with active bleed. Initial attempt was made to achieve haemostasis and salvage the graft kidney, but due to uncontrolled bleed, explantation was performed. Histologyshowed features of acute tubular injury. However there was no evidence of acute rejection, ATN or vascular thrombosis. Conclusion:This case demonstrates that early diagnosis and prompt treatment of a life-threatening condition like renal allograft rupture with explantation of the graft may be required in certain conditions as a life saving procedure.