Hemorrhagic shock due to bleeding from an arteriovenous fistula after allograft biopsy in a kidney transplant recipient: a case report

Abstract

Arteriovenous fistula (AVF) after allograft biopsy occurs in 1.6-8.3% of kidney transplant patients and most cases remain asymptomatic. Here, we report a case of hemorrhagic shock in a kidney transplant recipient following bleeding from an AVF after graft biopsy. Immediate intensive care including angiographic embolization saved the patient and the allograft. A 62-year-old woman with end-stage renal disease caused by diabetic nephropathy underwent ABO-incompatible kidney transplantation. No complications occurred in the early postoperative period. However, serum creatinine levels did not decrease sufficiently and decreased graft diastolic blood flow was noted on ultrasound. Therefore, at 14 days after kidney transplantation, allograft biopsy was performed to elucidate the cause of allograft dysfunction. At 5 days after allograft biopsy, the patient developed hemorrhagic shock caused by bleeding from an AVF in the allograft. We immediately performed angiographic embolization, and her vital signs improved without deterioration in renal function. AVF can cause hemorrhagic shock, and angiographic embolization is effective for treating it.

Arteriovenous fistula in a renal allograft with gross hematuria and subsequent acute kidney injury due to urinary tract obstruction: a case report

“…In most patients, the AVF resolves spontaneously, although they remain symptomatic in 30% of patients [ 6 ]. Hematuria is the most common symptom of renal transplant AVF [ 4 – 6 ], causing renal dysfunction, hypertension, and hemorrhagic shock due to bleeding from the AVF [ 13 , 14 ]. AVF often occurs early to 1 year after renal allograft biopsy [ 4 , 5 , 9 , 13 , 14 ], and a history of multiple renal allograft biopsies has been reported as a high-risk factor for AVF development [ 16 , 17 ].…”

“…Although severe hematuria from a renal transplant AVF after renal allograft biopsy has been reported [ 13 , 14 ], sudden-onset hematuria from an asymptomatic renal transplant AVF has not been reported. This study presents a patient with sudden hemorrhage from a renal transplant AVF that resulted in acute kidney injury (AKI).…”

Postoperative and Recurrent Hematuria after Pretransplant Core Needle Biopsy in Living Donor Kidney Transplant

“…In conclusion, in spite of the widespread use of core needle biopsy, as one of the methods to obtain a baseline allograft renal biopsy, it still carries some risk complications including AVF as one of the major vascular complications and it might be devastating as massive bleeding leading to hemorrhagic shock [ 17 ]. The effect of the forming AVF can be seen immediately or even in a late fashion, and it might affect the graft function as well.…”

Treatment of post-biopsy arteriovenous fistula of a renal graft by selective embolization

“…The presence of an AVF in most vessels has little clinical relevance; however, in some cases, it can cause hematuria, hypovolemia, hypertension, and less frequently renal graft dysfunction. [ 9 12 13 14 ]…”

“…[ 3 15 ] Some groups suggest expectant management, considering that in up to 70% of patients, AVF resolves spontaneously within the first 2 years. [ 2 12 ] Barrios et al . suggest performing ultrasound Doppler to check the graft every week for a month, and then monthly until the AVF is closed.…”