PTFE Mesh in Renal Allograft Compartment Syndrome

Maione, C.; Gambino, G.; Bona, Anna Di; Luna, Emerico; Turco, Danilo; Scio, Antonio; Damiano, Giuseppe; Virzi, Cristina; Gioviale, Maria Concetta; Buscemi, Giuseppe; Romano, Maurizio; Monte, Attilio Ignazio Lo

doi:10.1016/j.transproceed.2006.02.139

Cited by 12 publications

(12 citation statements)

References 9 publications

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“…Furthermore, if RACS is unrecognized the graft may be lost. Renal allograft compartment syndrome has been defined as EAD secondary to intra‐abdominal hypertension leading to transplant ischaemia [1,2]. It occurs early after renal transplantation where closure of anterior abdominal wall seems to compress the transplant in the limited retroperitoneal space.…”

Section: Introductionmentioning

confidence: 99%

“…It occurs early after renal transplantation where closure of anterior abdominal wall seems to compress the transplant in the limited retroperitoneal space. Both the pathogenesis and treatment of RACS in renal transplantation are poorly understood [2]. Hence, our report describes the diagnostic features and management of RACS in two recipients.…”

Section: Introductionmentioning

confidence: 99%

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Salvaging kidneys with renal allograft compartment syndrome

Heer¹,

Trevillian²,

Hardy³

et al. 2012

Transplant International

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Summary Renal allograft compartment syndrome is an under recognized cause of early allograft dysfunction which can be reversed by early intervention. It occurs early after renal transplantation where closure of the anterior abdominal wall seems to compress the transplant in the limited retroperitoneal space. The literature about this syndrome in renal transplantation is sparse. Our report describes the diagnostic criteria and the management of two renal transplant recipients with this syndrome. Its diagnosis depends upon duplex vascular scan findings of reversed or absent diastolic flow in the renal vasculature in the absence of any perigraft collection or severe acute tubular necrosis. In our hands emergency laparotomy, decompression of the transplant and closure with interposition mesh salvaged these kidneys.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Salvaging kidneys with renal allograft compartment syndrome

Heer¹,

Trevillian²,

Hardy³

et al. 2012

Transplant International

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“…Some authors have emphasized the risk of postoperative intestinal obstruction and bowel fistula in intraperitoneal positioning of the mesh, 21,22 but the use of a hydrophobic material with reduced porosity (ePTFE) has minimized this complication. 20,23 This straightforward technique involves minimal dissection and allows the aponeuroses, muscles, and subcutaneous tissues to remain intact. Proper positioning of the ePTFE prosthesis is extremely important; specifically, the material must be placed intraperitoneally so that it exceeds the hernia ring beyond 5 cm.…”

Section: Discussionmentioning

confidence: 99%

Use of Intraperitoneal ePTFE Gore Dual-Mesh Plus in a Giant Incisional Hernia After Kidney Transplantation: A Case Report

Monte

Damiano

Maione

et al. 2009

Transplantation Proceedings

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We evaluated the incidence of and predisposing factors for an incisional hernia after kidney transplantation. Numerous techniques have been used to repair postoperative fascial dehiscences or simple incisional hernias, but no clear treatment exists for giant hernias. Our aim was to obtain (1) a safe procedure to repair a large abdominal defect and reinforce the surrounding, fragile zones and (2) a simple, rapid technique to reduce the operative time. Herein we have described the surgical repair of a giant incisional hernia using intraperitoneal Gore ePTFE dual-mesh plus (Gore-Tex; W. L. Gore, Flagstaff, Ariz, USA) in a 55-year-old man status-post renal transplantation. Total necrosis of distal graft ureter had caused a giant urinoma. The patient was reexplored on day 2 posttransplantation with a primary fascial approximation. Thirty days after transplantation we discovered a large incisional hernia and performed a repair. No drain was used. The patient continued immunosuppressive therapy (cyclosporine, mycophenolate mofetil, prednisolone) and was discharged on postoperative day 4 with no complications. An ultrasonographic follow-up at 1 year revealed the prosthesis to be correctely positioned. Incisional hernia is not rare after renal transplantation but the real incidence is unknown. Immunosuppressive therapy, prolonged pretransplantation dialysis, obesity, and diabetes are probably the major causes of incisional hernias in these patients. Surgical complications of renal transplantation surgery, such as wound hematoma, urinoma, and lymphocele, are the most important predisposing factors for an incisional hernia. The use of intraperitoneal ePTFE dual-mesh is feasible, safe, and easy to repair a large incisional hernia in a kidney transplant patient.

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“…Our group used prosthetics dual-mesh PTFE, for the onset of RACS in a 42-year-old female kidney transplanted patient, in which compartment syndrome was due to the narrow space in which the graft was transplanted [1]. The closure of the abdominal wall with tension-free technique has allowed us to recover the functionality of the graft.…”

Section: Treatment Of Racsmentioning

confidence: 99%

“…In the absence of prompt treatment, it can have devastating effects, including the loss of the graft. If the transplanted kidney is too big for the size of the shallow false pelvis and the limited retroperitoneal space, increased pressure will be transmitted to the graft and causing graft ischemia with reduction of renal function (by 25% with an increased pressure between 15 and 20 mm Hg, and the onset of anuria when the pressure is higher than 20 mm Hg) [1].…”

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confidence: 99%

Renal Allograft Compartment Syndrome: Is It Possible to Prevent?

Damiano

Maione

Maffongelli

et al. 2016

Transplantation Proceedings

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Renal allograft compartment syndrome (RACS) is a complication characterized by increased pressure over 15 to 20 mm Hg of the iliac fossa site of transplanted kidney that can lead to a reduction of the blood supply to the graft, resulting in organ ischemia. This study aims to evaluate, through a review of the literature, the incidence, detection, treatment, and possible prevention of RACS. The incidence of this complication, which appears generally in the immediate post-transplantation period, is currently approximately 1% to 2% and is underestimated because of poor nosography for the presence of symptoms common to other post-transplantation complications. Doppler ultrasound is indispensable to evaluate the graft function in the immediate postoperative period and in the following days. The onset of RACS involves a surgical decompression of the graft and the subsequent closure of the abdominal wall with tension-free technique. Several authors agree that only the immediate surgical decompression following an early diagnosis can ensure a recovery of the graft. Early detection of the RACS is the key to preventing the loss of the graft. It is desirable to prevent this syndrome by reducing the discrepancy in weight between donor and recipient by 17%. However the shortage of organs makes such a selection not easy; therefore, in cases at risk for RACS, a close instrumental and clinical monitoring of the patient during post-transplantation recovery is recommended, so a prompt surgical decompression can be performed if RACS is suspected.

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PTFE Mesh in Renal Allograft Compartment Syndrome

Cited by 12 publications

References 9 publications

Salvaging kidneys with renal allograft compartment syndrome

Salvaging kidneys with renal allograft compartment syndrome

Use of Intraperitoneal ePTFE Gore Dual-Mesh Plus in a Giant Incisional Hernia After Kidney Transplantation: A Case Report

Renal Allograft Compartment Syndrome: Is It Possible to Prevent?

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