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Abstract

A 62-year-old male patient with diabetes underwent deceased-donor kidney transplant at our transplant unit. At reperfusion, a small and clinically not significant subcapsular hematoma was noted. The patient's postoperative course was characterized by delayed graft function since the beginning but was further complicated on postoperative day 6 by evidence (shown at daily Doppler ultrasonography) of a wide increase of the hematoma. The hematoma, which was just visible before, was now leading to graft compression because it covered up to two-thirds of the cortical surface. The patient showed no hemodynamic instability and showed no significant drop in hemoglobin values. Capsulotomy was not performed because it was deemed too risky. The patient was given strict follow-up with Doppler ultrasonography and high-resolution imaging techniques (magnetic resonance imaging and computed tomography scan). In the following days, spontaneous resolution of the hematoma and progressive improvement of Doppler findings were observed, which preceded full recovery of graft function. Conservative management, in hemodynamically stable patients, seems to be a valid approach of this condition. By avoiding surgery or other interventional procedures, a conservative approach allows reduced risk of further complications. Strict monitoring with Doppler ultrasonography is a valid tool for follow-up, along with high-resolution imaging techniques such as magnetic resonance imaging and computed tomography to confirm diagnosis.

Oliguria due to extensive subcapsular hematoma in renal graft: does surgical intervention ensure better outcomes?

“…It can safely be used within the first 24-48 h post-transplantation to detect the presence of and to monitor the evolution of subcapsular hematomas [3]. Different approaches used for the treatment of subcapsular hematoma include conservative management or surgical intervention including percutaneous drainage, capsulotomy or even nephrectomy [4,5]. Here we have reported the case of a 58-year-old male patient who developed SH post-operatively with resultant oliguria for which surgical intervention was done.…”