J Nephropathol. 2019;8(1):10-10.
doi: 10.15171/jnp.2019.10
  Abstract View: 122
  PDF Download: 124

Case Report

Treatment of large renal allograft arterial pseudoaneurysm with in situ cold perfusion, ex vivo vascular reconstruction and reimplantation

Brent Taiting Xia 1, Aleksandr Aleksandrovich Reznichenko 1, Madison Colyn Cuffy 1 * , Ervin Steve Woodle 1

1 Department of Surgery, Division of Transplantation, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA

Abstract

Background: Pseudoaneurysm after renal transplantation is a rare but serious complication.

Case Presentation: We report a case of a 76-year-old man who presented six weeks after kidney transplant with a large pseudoaneurysm arising from the renal artery anastomosis, causing renal vein compression and renal allograft dysfunction. Prior to the removal of the transplanted kidney, an in situ cold perfusion of the allograft was performed. The pseudoaneurysm was repaired ex vivo and the renal artery was reconstructed. External iliac vein was reconstructed with deceased donor interposition allograft, and the kidney was then re-implanted. The patient recovered with immediate allograft function.

Conclusions: Successful surgical management of a large renal allograft arterial pseudoaneurysm involves avoidance of dissection of the pseudoaneurysm, utilization of in situ cold perfusion and en-bloc removal of the kidney together with pseudoaneurysm, and pseudoaneurysm incision and vascular bypass reconstruction ex vivo

Implication for health policy/practice/research/medical education:

Following renal transplant, the development of arterial pseudoaneurysm may result in significant morbidity and mortality. In this case report of a patient who developed a large allograft arterial pseudoaneurysm six weeks after transplant that resulted in allograft dysfunction, we demonstrate successful surgical management, resulting in patient recovery and allograft function. Physicians and surgeons should be aware of this rare complication as a differential to the presentation of allograft dysfunction, and the important principles and techniques used in repairing this challenging scenario.

Please cite this paper as:Xia BT, Reznichenko AA, Cuffy MC, Woodle ES. Treatment of large renal allograft arterial pseudoaneurysm with in situ cold perfusion, ex vivo vascular reconstruction and re-implantation. J Nephropathol. 2019;8(1):e10. DOI: 10.15171/jnp.2019.10.

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Submitted: 06 Jun 2018
Accepted: 07 Jul 2018
First published online: 23 Jul 2018
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