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Simultaneous Pancreas-Kidney Transplant Complicated by Kidney Allograft Torsion and Pseudoaneurysms of the Y-Allograft: A Case Report and Review of the Literature. Case Rep Nephrol 2022; 2022:1748141. [DOI: 10.1155/2022/1748141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/01/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022] Open
Abstract
Background. We report and review the literature of two rare complications of simultaneous pancreas-kidney transplantation (SPKT) occurring in one patient. Case Report. A 39-year-old man with dialysis-dependent kidney failure secondary to type 1 diabetes mellitus underwent successful SPKT in October 2018. Three months later, he presented with an acute kidney injury (AKI) and returned to dialysis. Kidney scintigraphy showed a central photopenic region, and angiograms showed absent flow in the kidney transplant artery without treatable thrombus and the incidental finding of two pseudoaneurysms of the pancreatic Y-graft. He remained dialysis-dependent for three weeks before spontaneous partial recovery of allograft function; repeat kidney scintigraphy showed significant improvement in perfusion. However, in April 2019 he was readmitted with a sudden deterioration in kidney allograft function again necessitating haemodialysis. Repeat imaging confirmed that the kidney allograft had shifted from the left iliac fossa to the midline. He underwent surgical exploration, during which torsion of the kidney allograft was confirmed and a nephropexy was performed. The kidney allograft was originally implanted in the left retroperitoneum via a midline transperitoneal approach, which likely predisposed it to torsion. The pseudoaneurysms of the pancreatic Y-graft were managed conservatively, and surveillance imaging demonstrated that they remained stable in size. The patient regained reasonable kidney allograft function (estimated glomerular filtration rate, eGFR, of 45 mL/min) and maintained normal pancreatic allograft function. Conclusion. Kidney allograft torsion should be considered post-SPKT in patients with AKI and absent arterial flow. Although most case reports describe surgical management of pseudoaneurysms post-SPKT, our case demonstrates successful conservative management.
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Renal allograft torsion, is sirolimus a culprit– Case series and review of literature. TRANSPLANTATION REPORTS 2021. [DOI: 10.1016/j.tpr.2021.100087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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George JT, Mar W. Partial Renal Transplant Torsion as a Cause of Abdominal Pain. J Clin Imaging Sci 2021; 11:51. [PMID: 34621596 PMCID: PMC8492442 DOI: 10.25259/jcis_154_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
Allograft torsion is a rare but potentially devastating outcome of renal transplantation. Patients typically present with an acute onset of abdominal pain, though symptoms are non-specific and can easily be missed in favor of more common diagnoses. Imaging, in particular ultrasound and computed tomography, can aid in the diagnosis of renal transplant torsion by demonstrating characteristic features, and once recognized immediate surgery is typically performed in an attempt to salvage the allograft. However, renal transplant torsion needs not be an acute event; patients can instead present with chronic, waxing, and waning symptoms if the allograft undergoes partial or intermittent torsion. The aforementioned characteristic imaging findings may not be present in this situation. It is essential to recognize partial, intermittent torsion as well, for which imaging can again play a role.
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Affiliation(s)
- Joseph T George
- University of Illinois at Chicago College of Medicine, Chicago, Illinois, United States
| | - Winnie Mar
- Department of Radiology, University of Illinois Hospital and Health Sciences, Chicago, Illinois, United States
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Vincenzi P, Sivan S, Shah R, Goggins MO, Morsi M. Recurrent Renal Allograft Torsion After Simultaneous Kidney and Pancreas Transplantation: Is it Still Possible to Salvage the Graft? A Case Report. Transplant Proc 2021; 53:2529-2535. [PMID: 34481647 DOI: 10.1016/j.transproceed.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Kidney allograft torsion (KAT) is defined as a rotation of the renal allograft around its vascular pedicle. It is a rare complication with high rate of graft loss. The nonspecific presentation and inability to provide a definitive diagnosis by imaging, mainly in cases of partial torsion, often delay the diagnosis and treatment. We report a case of recurrent complete torsion of the renal allograft after simultaneous kidney and pancreas transplantation, requiring 2 emergency exploratory laparotomies. CASE REPORT A 38-year-old woman with a history of intraperitoneal simultaneous kidney and pancreas transplantation underwent 2 separate emergency exploratory laparotomies secondary to complete renal allograft torsion, respectively, 7 and 11 months after the transplant. In both episodes, no adhesions were encountered. During the first operation, nephropexy was performed. During the second operation, an abdominal wall mesh was placed and fixed to the abdominal wall. Acute kidney injury related to KAT recovered in both occasions with a creatinine of 1.3 mg/dL at 4 months follow-up. CONCLUSIONS Renal torsion always should be suspected in intraperitoneally placed kidneys presenting with nonspecific symptoms, abdominal pain, oliguria, and worsening kidney function. Surgical exploration should be considered to salvage the renal graft. This case illustrates the reversibility of a severe injury related to this vascular complication with an adequate return to baseline kidney function even when diagnosis and surgical treatment of KAT might be delayed secondary to its misleading clinical presentation.
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Affiliation(s)
- Paolo Vincenzi
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida.
| | - Shobana Sivan
- Department of Medicine, Division of Transplant Nephrology, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Rushi Shah
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Mariella Ortigosa Goggins
- Department of Medicine, Division of Transplant Nephrology, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Mahmoud Morsi
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
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A comprehensive radiologic review of abdominal and pelvic torsions. Abdom Radiol (NY) 2021; 46:2942-2960. [PMID: 33388807 DOI: 10.1007/s00261-020-02868-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
The clinical manifestations of abdominal and pelvic organ torsion can often be non-specific and can affect a wide range of ages and demographic groups. Radiologists have a key role in not only establishing the diagnosis of organ torsion, but also in the assessment of potential complications. As multiple imaging modalities may be utilized in the evaluation of abdominal and pelvic pain, recognizing the various appearances of organ torsion is important to ensure early diagnosis and thereby reducing patient morbidity and mortality, particularly since abdominal and pelvic organ torsion may not be clinically suspected at the time of initial patient presentation.
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Torabi J, Rocca JP, Choinski K, Lorenzen KA, Ajaimy M, Graham JA. Renal Allograft Torsion Following Simultaneous Pancreas Kidney Transplant Should Be Suspected With Sustained Kidney Injury With Normal Pancreas Function. Prog Transplant 2018; 28:396-397. [PMID: 30213234 DOI: 10.1177/1526924818800041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Julia Torabi
- 1 Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juan P Rocca
- 1 Albert Einstein College of Medicine, Bronx, NY, USA.,2 Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | | | - Katherine A Lorenzen
- 2 Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Maria Ajaimy
- 1 Albert Einstein College of Medicine, Bronx, NY, USA.,2 Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Jay A Graham
- 1 Albert Einstein College of Medicine, Bronx, NY, USA.,2 Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
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Pery R, Shaharabani E, Gazer B, Gutman M, Rosin D. Laparoscopic Fixation for Torsion of Transplanted Kidney: A Case Report. Transplant Proc 2017; 49:2378-2380. [PMID: 29198683 DOI: 10.1016/j.transproceed.2017.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 09/23/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Kidney graft torsion and subsequent acute kidney injury is a rare yet potentially devastating complication of intraperitoneal kidney transplant. We report a case of this elusive diagnosis and describe kidney salvage by using laparoscopic fixation. CASE REPORT A 49-year-old male patient presented with multiple episodes of anuric acute kidney injury 16 months after an uneventful combined orthotopic liver and kidney transplantation. After a thorough investigation, a diagnosis of kidney torsion was made, and the patient was urgently operated. Upon surgery, a complete torsion of a viable kidney was found. Laparoscopic fixation was achieved by using an absorbable mesh "pocket." The patient has experienced no similar episodes in the subsequent year. CONCLUSIONS Nephrologists and surgeons should be aware of this rare complication. Prompt diagnosis and operative repair are crucial to save the graft. Prophylactic nephropexy should be considered in all intraperitoneal transplantations.
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Affiliation(s)
- R Pery
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - E Shaharabani
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Gazer
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Gutman
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Rosin
- Department of General Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Renal Allograft Torsion: US and CT Imaging Findings of a Rare Posttransplant Complication. Case Rep Radiol 2016; 2016:4273780. [PMID: 27088027 PMCID: PMC4818807 DOI: 10.1155/2016/4273780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/24/2016] [Indexed: 12/04/2022] Open
Abstract
Vascular torsion is a rare renal transplant complication which requires prompt diagnosis and surgery to salvage allograft function. We report here a case of renal allograft torsion with interesting imaging findings on unenhanced CT and color Doppler ultrasound. A 60-year-old woman with a history of pancreas and kidney transplant presented to the emergency room with nausea, vomiting, abdominal pain, and minimal urine output. Unenhanced CT of the abdomen demonstrated an enlarged and malrotated renal allograft with moderate hydronephrosis. Color Doppler ultrasound demonstrated lack of vascularity within the allograft. The patient was taken urgently to the operating room where the renal allograft was found twisted 360 degrees around the vascular pedicle. After the allograft was detorsed, the color of the kidney returned and the Doppler signals for arterial flow improved. Intraoperative biopsy showed no evidence of infarct or acute cellular rejection. The detorsed kidney was surgically fixed in position in its upper and lower poles. Follow-up ultrasound 1 day later demonstrated normal blood flow to the renal allograft and the serum level of creatinine returned to normal.
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Vasanawala SS, Nguyen KL, Hope MD, Bridges MD, Hope TA, Reeder SB, Bashir MR. Safety and technique of ferumoxytol administration for MRI. Magn Reson Med 2016; 75:2107-11. [PMID: 26890830 DOI: 10.1002/mrm.26151] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/10/2016] [Accepted: 01/15/2016] [Indexed: 12/12/2022]
Abstract
Ferumoxytol is an ultrasmall superparamagnetic iron oxide agent marketed for the treatment of anemia. There has been increasing interest in its properties as an MRI contrast agent as well as greater awareness of its adverse event profile. This mini-review summarizes the current state of knowledge of the risks of ferumoxytol and methods of administration.
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Affiliation(s)
| | - Kim-Lien Nguyen
- Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Michael D Hope
- Department of Radiology, University of California, San Francisco
| | | | - Thomas A Hope
- Department of Radiology, University of California, San Francisco
| | - Scott B Reeder
- Departments of Radiology, Medical Physics, Biomedical Engineering, and Emergency Medicine, University of Wisconsin, Madison, WI
| | - Mustafa R Bashir
- Center for Advanced Magnetic Resonance Development and Department of Radiology, Duke University, Durham, NC
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