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Case Reports in Transplantation
Volume 2011 (2011), Article ID 512893, 5 pages
http://dx.doi.org/10.1155/2011/512893
Case Report

Late Renal Allograft Rupture Associated with Cessation of Immunosuppression following Graft Failure

1Division of Nephrology, Department of Medicine, King Abdulaziz Medical City, P.O. Box 22490, Riyadh 11426, Saudi Arabia
2Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, P.O. Box 22490, Riyadh 11426, Saudi Arabia
3King Abdullah International Medical Research Centre and College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, P.O. Box 22490, Riyadh 11426, Saudi Arabia
4Department of Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, P.O. Box 22490, Riyadh 11426, Saudi Arabia

Received 9 September 2011; Accepted 11 October 2011

Academic Editors: A. Beiras-Fernandez and Y. Sugawara

Copyright © 2011 Sumayah Askandarani et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 29-year-old man developed chronic allograft nephropathy 63 months after renal transplantation. He became symptomatic with advanced chronic graft failure; his immunosuppressive medications were reduced and he was commenced on haemodialysis. Two months following the withdrawal of immunosuppression, he presented with abdominal pain, haematuria, and a marked drop in haemoglobin. The patient was taken to the operating room, where the renal allograft was found to be ruptured, and graft nephrectomy was subsequently performed. Histological examination of the graft specimen showed severe haemorrhagic acute vascular cellular rejection in a background of marked chronic allograft vasculopathy. Immunostaining for C4d showed diffuse, strong, linear circumferential staining of the peritubular capillaries, indicating a concurrent antibody-mediated rejection. We report herein an unusual case of spontaneous renal allograft rupture that occurred long time after transplantation due to severe acute rejection following cessation of immunosuppressive medications for advanced chronic allograft failure. To the best of our knowledge, the time interval between transplantation and the rupture of this allograft is the longest of those reported in the literature.