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.

Unexpected presentation of allograft dysfunction triggered by page kidney phenomenon immediately after kidney transplantation: a case report

“…Reportedly, PK for allograft is caused mainly by allograft biopsy and trauma. Risk factors for the development of PK for allograft are not well established [ 5 , 8 ]. Takahashi et al summarized previous reports, and the most common causes were iatrogenic, meaning allograft biopsy and three cases lost their allograft function [ 5 ].…”

“…Risk factors for the development of PK for allograft are not well established [ 5 , 8 ]. Takahashi et al summarized previous reports, and the most common causes were iatrogenic, meaning allograft biopsy and three cases lost their allograft function [ 5 ]. Although the cause of subcapsular bleeding was unclear in this case, a small cyst of the allograft, which might rupture at donor nephrectomy, was located in the middle of hematoma, and oozing around the cyst was observed.…”

Page Kidney Phenomenon following Kidney Graft Biopsy

“…In the experiment, cellophane was wrapped around a native kidney leading to the constriction in renal parenchyma and hypertension [7]. In the context of kidney transplantation, Page kidney phenomenon can occur spontaneously after kidney transplantation [8,9], after percutaneous kidney graft biopsy [5,[10][11][12], or after trauma to the allograft [13]. It can also occur in a native kidney [14].…”

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“…Several causes can lead to the onset of SH. These can be classified as traumatic (eg, renal injuries at organ procurement, 1,6 allograft trauma in transplant patients, 3,7 and trauma during posttransplant biopsy 8 ) or not traumatic, which are generally related to specific medical conditions causing spontaneous bleeding (eg, pancreatitis and warfarin therapy). In some cases, the cause is unknown, especially in those who have late onset of SH after transplant.…”

“…Indeed, different options have been proposed, including conservative management, 1 interventional procedures such as percutaneous drainage, 2 or more often surgical capsulotomy. 3 The choice of how to approach SH is crucial for both patient and graft outcomes because of the risk of further patient morbidity and even graft loss. Here, we describe our experience of an extensive SH aroused postoperatively and causing a prolonged delayed graft function (DGF), which was successfully treated with a conservative approach.…”