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Acute torsion of the renal transplant after combined kidney-pancreas transplant. Transplantation 1999 Feb 15;67(3):486-8

Date

02/25/1999

Pubmed ID

10030301

DOI

10.1097/00007890-199902150-00026

Scopus ID

2-s2.0-0033557272   23 Citations

Abstract

BACKGROUND: Surgical complications after combined kidney and pancreas transplantation are a major source of morbidity and mortality. Complications related to the pancreas occur with greater frequency as compared to renal complications. The occurrence in our practice of two cases of renal infarction resulting from torsion about the vascular pedicle led to our retrospective review of similar vascular complications after combined kidney and pancreas transplantation.

METHODS: Charts were reviewed retrospectively, and two patients were identified who experienced torsion about the vascular pedicle of an intra-abdominally placed renal allograft.

RESULTS: Two patients who had received combined intraperitoneal kidney and pancreas transplantation presented at 16 and 11 months after transplant, respectively, with abdominal pain and decreased urine output. One patient had radiological documentation of abnormal rotation before the graft loss; unfortunately, the significance of this finding was missed. Diagnosis was made in both patients at laparotomy, where the kidneys were infarcted secondary to torsion of the vascular pedicle. Both patients underwent transplant nephrectomy and subsequently received a successful second cadaveric renal transplant.

CONCLUSIONS: The mechanism of this complication is a result of the intra-abdominal placement of the kidney, length of the vascular pedicle, excess ureteral length, and paucity of adhesions secondary to steroid administration. These factors contribute to abnormal mobility of the kidney. Technical modifications such as minimizing excess ureteral length and nephropexy may help to avoid this complication.

Author List

Roza AM, Johnson CP, Adams M

Authors

Christopher P. Johnson MD Professor in the Surgery department at Medical College of Wisconsin
Allan M. Roza MD Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Diabetes Mellitus, Type 1
Diabetic Nephropathies
Female
Hemorrhage
Humans
Infarction
Kidney Failure, Chronic
Kidney Transplantation
Male
Middle Aged
Pancreas Transplantation
Postoperative Complications
Reoperation
Retrospective Studies
Torsion Abnormality
jenkins-FCD Prod-478 d1509cf07a111124a2d122fd3df854cc0b993c00